A 65-year-old male presented with chronic cough, weight loss, and fatigue, initially misdiagnosed as community-acquired pneumonia. Despite antibiotic treatment, his condition worsened, developing skin lesions and osteomyelitis. Extensive diagnostic workup, including biopsies of skin and bone, eventually identified Coccidioides immitis through histopathology and culture. The patient, residing in an endemic area, experienced significant delay in diagnosis, leading to disseminated coccidioidomycosis. This case underscores the importance of considering endemic fungal infections in patients with non-resolving respiratory symptoms, especially in high-risk regions, to prevent severe disease progression.
Key note: Clinicians must maintain a high index of suspicion for endemic fungal infections in appropriate geographic and clinical contexts.