Coccidioidal Endophthalmitis in Immunocompetent Person, California, USA

To the Editor: In the United States, dimorphic fungi of the species Coccidioides are endemic to California (particularly the Central Valley), southern Arizona, southern New Mexico, and western Texas.Although there are a relatively large number of coccidioidomycosis cases in the United States (≈150,000/year), intraocular coccidioidomycosis is uncommon (1,2).We report a case of coccidioidal endophthalmitis in an immunocompetent person.In October 2010, a 55-year-old white man in Santa Clarita, California, had severe pneumonia, drenching sweats, and an associated 25-pound weight loss.Three weeks later, when his symptoms had nearly resolved, the man reported having scratched his left eye with his eyeglasses and subsequent development of increasing redness, pain, and progressive vision loss (from 20/10 to 20/60 without correction).In November 2010, the man sought the care of an ophthalmologist, who noted panuveitis of the left eye.Laboratory testing was performed: the erythrocyte sedimentation rate was 49 mm/h (reference 0-22 mm/h), and test results were negative for human leukocyte antigen B27, angiotensinconverting enzyme, rapid plasma reagin, and antinuclear antibody.