Coccidioidomycosis is a dimorphic fungus appearing in the soil as a saprophyte mycelium and in tissue as a parasitic spherule. In symptomatic patients, fever, headache, cough and pleuritic pain are common. Erythema nodosum and multiforme may be seen. A serious pulmonary infection with cavitation may be seen. Immunosuppression may lead to dissemination as well.
Cutaneous metastases are the commonest form of extrapulmonary dissemination.
Osteomyelitis of the skull or vertebral bodies is also common. Spinal compression from parav ertebral abscesses may be seen. One third of patients with disseminated disease develop meningitis either from h ematogenous source or airborne. The course may be fulminant, but most often appears as relapses. Inflammation is most intense at the base of the brain where cranial nerve palsies, cerebellar dysfunction, and hydrocephalus may be found.