All That Coughs Is Not Covid-19: A Delayed Diagnosis of Disseminated Coccidioidomycosis Following SARS-CoV-2

Coccidioides immitis (and C. posadasii) are endemic fungi of the southwestern United States and northern Mexico. Uncomplicated, symptomatic Coccidioides infection most commonly causes a self-limited pneumonia; however, immunocompromised patients can manifest severe pneumonia with an additional risk of dissemination to bone, joints, soft tissues, and in the most severe the cases, the central nervous system. In the year 2020 clinicians are challenged with a previously unseen volume of acute respiratory complaints as a result of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. We present a patient with respiratory failure secondary to SARS-CoV-2 who experienced prolonged hypoxia and neurologic deterioration, eventually leading to a diagnosis of occult disseminated coccidiomycosis involving meningitis, miliary-pattern pneumonia, and cutaneous lesions.