Interstitial granulomatous dermatitis associated with pulmonary coccidioidomycosis

Background: Coccidioides immitis is a soil-dwelling fungus found in arid re gions of the Western Hemisphere. Interstitial granulomatous dermatitis is a histopathologic pattern that may be a reactive manifestation of diverse sy stemic diseases. Objective: Our purpose was to describe clinical and histopathologic finding s in 5 patients who presented with interstitial granulomatous dermatitis as sociated with pulmonary coccidioidomycosis. Methods: Medical records and skin biopsy slides from 5 patients were retros pectively reviewed. Results: In each patient, edematous papules, nodules, and plaques developed abruptly during the onset of an acute febrile illness. Coccidioidomycosis was confirmed by serology Skin biopsy specimens revealed interstitial granu lomatous dermatitis vith neutrophils, leukocytoclasis, and eosinophils. Fun gal stains (5/5 cases) and fungal cultures (2/2 cases) revealed no organism s within the skin biopsy specimens. Conclusion: Interstitial granulomatous dermatitis may be a presenting featu re of pulmonary coccidioidomycosis and may possibly represent a reactive ma nifestation of the infection.