Cervical, Mediastinal, and Pericardial Disseminated Coccidioidomycosis: The Importance of Source Control.

A 47-year-old healthy man developed disseminated coccidioidomycosis involving his mediastinal and cervical lymph nodes that was complicated by pericardial involvement despite continued fluconazole for primary pulmonary infection. Although he subsequently received an aggressive antifungal regimen with voriconazole and liposomal amphotericin B, he did not clinically improve until he underwent major debridement and drainage, highlighting the need for source-control procedures in some cases of severe disseminated coccidioidomycosis.