Pulmonary coccidioidomycosis acquired during travel-a diagnostic and therapeutic challenge.

Reports of coccidioidomycosis are rare outside the Western hemisphere. We report the case of a 57 year-old Israeli who had returned from California with pneumonia. As his condition had deteriorated despite macrolides and beta-lactams, coccidioidomycosis was suspected. Both sputum culture and serology confirmed the diagnosis. Conventional doses of fluconazole were marginally beneficial, and a complete resolution was achieved only with very high doses. Travel to the South-Western United States may expose travelers to this uncommon disease.