Coccidioidomycosis causing massive cervical lymphadenopathy

Coccidioidomycosis involving the head and neck is uncommon. We present a case of a patient with disseminated coccidioidomycosis and massive submandibular cystic lymphadenopathy unresponsive to systemic antifungal treatment. It is our impression that significant clinical improvement resulted from concomitant needle aspiration of the cystic nodes to decrease fungal load and modification of systemic medication. Although reduction of fungal burden may provide an improved response to antifungal therapy, disseminated coccidioidomycosis is a systemic disease that requires appropriate systemic therapy.