Cutaneous Coccidioidomycosis Mimicking Rosacea in Immunosuppressed Patient, Arizona, USA, 2024.

An immunocompromised patient in Arizona, USA, experienced cutaneous coccidioidomycosis mimicking rosacea-like dermatitis; she was receiving vandetanib therapy. Histopathology confirmed the diagnosis despite inconclusive serologic results. Lesions resolved with fluconazole treatment, but blue-gray hyperpigmentation persisted, likely linked to vandetanib. This case highlights diagnostic challenges in endemic fungal infections and rare drug-associated hyperpigmentation.