Abstract Introduction Coccidioidomycosis, commonly known as “Valley Fever” is a fungal infection that commonly infects the lungs creating cavitary lesions. Per the CDC, Coccidioides is endemic to the Southwest region of the United States with reaching up to the Pacific Northwest. Due to this idea of endemic regions, diagnosis can be delayed as it would be much lower on physician differentials in non-endemic regions. As location plays a large role, a thorough travel and work history is necessary with patients presenting to non-endemic regions with symptoms of Valley Fever. This case involves a patient who presented in the Southeast region with symptoms of Coccidioidomycosis with fever, productive cough, and dyspnea. Case A 41-year-old male with frequent travel to the Southwestern US to West Texas for work in the oil field admitted for symptoms concerning for pneumonia. CT angiogram of the thorax reported multifocal pneumonia with small right upper lobe cavitary component and reactive lymphadenopathy. A comprehensive infectious workup was ordered and all in-hospital labs, including cryptococcus, respiratory viral panel, urine Streptococcus, urine Legionella, urine Histoplasma, urine Blastomyces, were unremarkable. Bronchoscopy with bronchoalveolar lavage (BAL) was performed and was negative for all bacteria, fungus, and malignancy. The patient symptomatically improved and was discharged with pulmonary follow-up with other infectious send-out labs pending. Prior to follow-up, the BAL returned positive for Aspergillus and was informed to return to the hospital for admission. Additionally, the patient’s Coccidioides returned with elevated IgM of 4.6 and IgG of 5.3. With patient’s immunocompetency, it was determined by Infectious Disease (ID) that the positive Aspergillus was likely cross-reactive with the positive Coccidioides IgM and IgG. He was initiated on oral fluconazole and discharged with Pulmonary and ID follow-up. Discussion Coccidioidomycosis was diagnosed through obtaining a thorough history. Even with this thorough social history, there was still time between presentation and diagnosis due to the patient’s home not being in an endemic area. With the patient presenting in the Southeastern region of the country, it is much less common of a diagnosis to obtain as fewer providers even have experience with Coccidioidomycosis as it often presents with nonspecific symptoms that could be related to a multitude of other pulmonary diseases. In conclusion, once common etiologies of pulmonary diseases have been ruled out, history and extensive laboratory testing is necessary as certain diseases can present anywhere in the country if not inherently endemic in the region that a physician practices. This abstract is funded by: None
Patel et al. (2026) studied this question.