A 56-year-old African American male police officer with Fitzpatrick type VI skin and chronic osteomyelitis due to coccidiomycosis developed a photodistributed eruption 2 months after initiating treatment with voriconazole, 400 mg twice daily. The patient was in good health until he was diagnosed as having coccidiomycosis while living in the endemic southern central valley area of California. He was initially treated with amphotericin for 2.5 years but developed renal insufficiency. His other medications were pantoprazole, fluticasone/salmeterol, gabapentin, valsartan, oxycodone/acetaminophen, and zolpidem.