Cutaneous lesions are a common manifestation of disseminated coccidioidomycosis, which has increasing prevalence in endemic regions. The clinical and histologic features may be more variable than is currently recognized.

To characterize the clinical and histologic findings from a large series of disseminated coccidioidomycosis cases in the southwestern United States.

Histologic materials and clinical records for all biopsy-positive cases (1975-2006) from three medical centers in Arizona were reviewed.

Patterns of inflammation were generally granulomatous, but the degree of organization, associated inflammatory milieu, density of tissue fungemia, and size of fungal spherules were highly variable. The clinical presentation was also inconsistent.

The study only included cases with diagnostic histology. Records of clinical information were somewhat incomplete.

Clinical and pathologic findings in disseminated cutaneous coccidioidomycosis are variable and often subtle. A diagnosis requires a high degree of suspicion, especially in patients who reside in or have traveled through endemic regions.