Primary cutaneous coccidioidomycosis. Reevaluation of its potentiality based on study of three new cases.

The data derived from these three young patients would indicate the need for: (1) Early recognition of the primary cutaneous skin infection as being due to Coccidioides immitis. (2) The prompt use of suppressive intravenous amphotericin B therapy until such time as local tissue resistance and systemic immunity become manifest and sufficient to contain the pathogenic fungus within the initial cutaneous site of infection as manifested by complete healing of this primary lesion and its associated lymphadenopathy. It is apparent that there is a need to reassess present concepts which have been based on insufficient data, and to revise conclusions derived from the study of the eight previously reported instances of primary cutaneous coccidioidomycosis. The traumatic cutaneous inoculation of C immitis into a previously uninfected person, contrary to earlier impressions, can result not only in prolonged illness but in serious dissemination of the disease, and in one reported instance has resulted in coccidioidal meningitis.