Coccidioidomycosis and Valley Fever Differential Diagnoses

Updated: Jul 11, 2017
  • Author: Duane R Hospenthal, MD, PhD, FACP, FIDSA, FASTMH; Chief Editor: Michael Stuart Bronze, MD  more...
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DDx

Diagnostic Considerations

A common pitfall is mistaking viral meningitis for coccidioidal meningitis in patients with meningitis and lymphocytic pleocytosis. The patient's travel history and area of residence have a major role in leading the clinician to the correct diagnosis. Findings of eosinophils in the CSF or hypoglycorrhachia are important. The progressive nature of the disease is inconsistent with a viral etiology.

The differential diagnoses of erythema nodosum are extensive. Coccidioidomycosis is perhaps one of the most significant associated conditions, and once again, the patient's travel history and area of residence are important. Patients with erythema nodosum generally have a benign course.

Other problems to be considered in the differential diagnosis of coccidioidomycosis include the following:

  • Acute respiratory distress syndrome
  • Blastomycosis
  • Enteropathic arthropathies
  • Eosinophilic Pneumonia
  • Histoplasmosis
  • Lung abscess
  • Lung cancer
  • Lymphoma
  • Myelophthisic anemia
  • Old granuloma
  • Paracoccidioidomycosis
  • Pericarditis (acute or chronic)
  • Sarcoidosis
  • Solitary pulmonary nodule

The differential diagnosis of cystic lesions seen on chest imaging studies in patients with possible coccidioidomycosis is as follows:

  • Blebs
  • Bullae
  • Pneumatoceles
  • Congenital cystic lesions
  • Traumatic lesions
  • Pneumocystis jiroveci pneumonia
  • Hydatid disease

The differential diagnosis of focal or multifocal cavitary lesions seen on chest imaging studies in patients with possible coccidioidomycosis is as follows:

  • Neoplasms (eg, bronchogenic carcinoma, lymphoma)
  • Immunologic disorders such as Wegener granulomatosis and rheumatoid nodule
  • Pulmonary infarct
  • Septic embolism
  • Lymphocytic interstitial pneumonia
  • Localized bronchiectasis

The differential diagnosis of diffuse involvement with cystic or cavitary lesions seen on chest imaging studies in patients with possible coccidioidomycosis is as follows:

  • Pulmonary lymphangioleiomyomatosis
  • Pulmonary Langerhans cell histiocytosis
  • Honeycomb lung associated with advanced fibrosis
  • Diffuse bronchiectasis
  • Metastatic disease

Differential Diagnoses