Last Updated: 2020-08-11

Author(s): Anzengruber F., Navarini A.

ICD11: 1F25.Z

  • Wernicke 1892
  • Posadas 1892

Coccidioid granuloma, desert rheumatism, valley fever, California disease, coccidioidomycosis, San Joaquin valley fever, desert fever.

Systemic fungal infection, mainly occurring in America.

  • Southern USA, Central and South America
  • Up to 15 times more common in Asians and black people.

  • Pathogen: Coccidioides immitis, a dimorphic fungus 
  • Incubation period: 10-18 days
  • The transmission takes place via dust. Primary infection can lead to the occurrence of erythema nodosum or erythema exsudativum multiforme
  • In < 1% of cases haematogenic scattering leads to further organ infestation (skin, bone and CNS)
  • Association with immunosuppression

  • The pathogens are inhaled via lungs, where inoculation occurs. The infection rarely occurs via skin. 
  • Flu-like symptoms (febrile temperatures, thoracic pain, cough, dyspnea, haemoptoe). 
  • Cutaneously, one can see verruciform, scar-healing granulomas, especially in the area of the nasolabial folds and on the capillitium. Abscess and fistula formation may occur

  • Pathogen detection (pus, sputum, bronchoalveolar lavage, blood, urine or cerebrospinal fluid) 
  • Biopsy 
  • Serologically specific antibody detection 
  • Intradermal skin test


  • The disseminated form can lead to a lethal course, if untreated.  
  • Frequent relapses. 

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