Erythema Nodosum and a Cavitary Lung Lesion in a Febrile Returned Traveler from Arizona: a Case of Coccidioidomycosis


Coccidioidomycosis incidence has been increasing recently in endemic regions. The disease can manifest with variable pulmonary and cutaneous presentations, challenging the clinical diagnosis. Our case highlights the differential diagnosis that must be considered for presentations of erythema nodosum and cavitating lung lesions and the importance of synthesizing the entire patient history—including travel history—for construction of appropriate diagnostic and treatment plans.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Data Availability

All data and materials are available from the authors.


  1. 1.

    Stockamp NW, Thompson GR 3rd. Coccidioidomycosis. Infect Dis Clin N Am. 2016;30(1):229–46.

    Article  Google Scholar 

  2. 2.

    DiCaudo DJ. Coccidioidomycosis: a review and update. J Am Acad Dermatol. 2006;55(6):929–42 quiz 943–925.

    Article  Google Scholar 

  3. 3.

    Garcia Garcia SC, Salas Alanis JC, Flores MG, et al. Coccidioidomycosis and the skin: a comprehensive review. An Bras Dermatol. 2015;90(5):610–9.

    Article  Google Scholar 

  4. 4.

    Queiroz-Telles F, Fahal AH, Falci DR, et al. Neglected endemic mycoses. Lancet Infect Dis. 2017;17:e367–77.

    Article  Google Scholar 

  5. 5.

    Blake T, Manahan M, Rodins K. Erythema nodosum – a review of an uncommon panniculitis. Dermatol Online J. 2014;20(4):22376.

  6. 6.

    Said S, Yanuck J, Burns M. A case of erythema nodosum with coccidioidomycosis. Clin Pract Cases Emerg Med. 2017;1(3):251–2.

    Article  Google Scholar 

  7. 7.

    Gafoor K, Patel S, Girvin F, et al. Cavitary lung diseases: a clinical-radiologic algorithmic approach. Chest. 2018;153(6):1443–65.

    Article  Google Scholar 

  8. 8.

    Malo J, Luraschi-Monjagatta C, Wolk DM, et al. Update on the diagnosis of pulmonary coccidioidomycosis. Ann Am Thorac Soc. 2014;11(2):243–53.

    Article  Google Scholar 

  9. 9.

    Spivey CG, Jones FL, Bopp RK. Cavitary coccidioidomycosis: experience in a tuberculosis hospital outside the endemic area. Dis Chest. 1969;56(1):13–8.

    Article  Google Scholar 

  10. 10.

    Freedman M, Jackson BR, McCotter O, Benedict K. Coccidioidomycosis outbreaks, United States and worldwide, 1940–2015. Emerg Infect Dis. 2018;24:417–23.

    Article  Google Scholar 

  11. 11.

    Diaz JH. Travel-related risk factors for coccidioidomycosis. J Travel Med. 2018;25(1).

  12. 12.

    Galgiani JN, Ampel NM, Blair JE, et al. Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis. Clin Infect Dis 2016. 2016;63:717–22.

    Article  Google Scholar 

  13. 13.

    Salzer HJF, Stoney RJ, Angelo KM, et al. Epidemiological aspects of travel-related systemic endemic mycoses: a GeoSentinel analysis, 1997–2017. J Travel Med. 2018;25(1):1–6.

    Article  Google Scholar 

  14. 14.

    Bezold CP, Khan MA, Adame G, et al. Notes from the field: increase in Coccidioidomycosis — Arizona, October 2017–March 2018. MMWR Morb Mortal Wkly Rep. 2018;67:1246–7.

    Article  Google Scholar 

Download references

Author information




AK, ANM, TC-K, and HR contributed to data extraction and literature review and were responsible for the initial draft of the manuscript. AKB conceived the report and contributed to data extraction, literature review, and writing of the manuscript. All authors revised the manuscript critically for important content and approved the final version for submission. All serve as guarantors of the work.

Corresponding author

Correspondence to Andrea K. Boggild.

Ethics declarations

Conflict of Interest

Aisha Khatib, Avinash N. Mukkala, Tianna Chong-Kit, and Hira Raheel each declare no potential conflicts of interest. Andrea K. Boggild is a Section Editor for Current Infectious Disease Reports.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Consent for Publication

The patient described herein provided verbal consent for scientific communication of her personal health information including images.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Tropical, Travel, and Emerging Infections

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Khatib, A., Mukkala, A.N., Chong-Kit, T. et al. Erythema Nodosum and a Cavitary Lung Lesion in a Febrile Returned Traveler from Arizona: a Case of Coccidioidomycosis. Curr Infect Dis Rep 23, 1 (2021).

Download citation


  • Cavitary lung lesion
  • Coccidioidomycosis
  • Erythema nodosum
  • Fever in the returning traveler
  • Valley fever