The skin is frequently a site of extrapulmonary dissemination in patie
nts with coccidioidomycosis. Clinical experience in an endemic area su
ggests an association between facial cutaneous coccidioidomycosis and
meningitis. Awareness of this association is important because coccidi
oidal meningitis is the most ominous site of spread in coccidioidomyco
sis. In this study, we assess whether cutaneous dissemination involvin
g the face is associated with meningitis to a greater degree than that
limited to the body. We retrospectively reviewed the medical records
of 201 patients from 1987 to 1996 with disseminated coccidioidomycosis
and found 30 patients with cutaneous involvement. Their mean age was
29.5+/-11.6 years; 20 patients were male; 14 were African American, 12
were Hispanic, 3 were white, and 1 was Asian. Nineteen patients had f
acial involvement, and 11 had isolated body involvement. Meningitis de
veloped in 11 patients, 10 with facial involvement and 1 with only bod
y involvement. Patients with facial lesions were more likely to have m
eningitis (odds ratio, 11.1; 95% confidence interval, 1.1 to 529, P=.0
23). The identification of a subgroup of patients at significant risk
of developing meningitis may allow earlier detection and perhaps impro
ved management of patients with meningeal disease.