Primary cutaneous coccidioidomycosis in an immunocompetent oil field worker in West Texas

Coccidioidomycosis is a disease endemic to the southwest United States, as well as Central and South America, and primarily causes pulmonary infection. The cutaneous findings associated with Coccidioides species often present as an exanthema or as dissemination from a primary pulmonary infection. Rarely do individuals present with primary cutaneous coccidioidomycosis due to direct inoculation of the skin by arthroconidia. We report a case in which an immunocompetent oil field worker presented with a severe, fungating nasal lesion, who with culture, serology, histopathology, and a convincing history of exposure revealed a diagnosis of primary cutaneous coccidioidomycosis.