Coccidioidomycosis as a rare cause of pneumonia in non-endemic areas: A short exposure history should not be ignored

Coccidioidomycosis is endemic in the south-western USA. Two cases of infection in travellers returning to Hong Kong are described. A previously healthy patient who had travelled to an endemic area for a short time was successfully treated with fluconazole. A second patient with comorbidities and more prolonged exposure had disseminated and eventually fatal disease, despite prolonged administration of anti-fungal agents. Although coccidioidomycosis is a rare disease in Hong Kong, it should always be considered when there is a relevant travel history. Even a short period of travel to an endemic area should alert clinicians to this possibility when managing patients with severe pneumonia, especially those with multi-organ involvement. On the other hand, in patients with comorbidities, even aggressive and prolonged anti-fungal therapy may not guarantee a successful outcome.