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July 1964

Primary Cutaneous Coccidioidomycosis

Arch Intern Med. 1964;114(1):149-153. doi:10.1001/archinte.1964.03860070195028

Erythema nodosum is the most frequent cutaneous manifestation in coccidioidomycosis. This hypersensitivity reaction usually develops two to three weeks following the initial pulmonary infection. Verrucous skin lesions or subcutaneous abscesses may develop when disseminated disease occurs from a primary pulmonary infection. Primary cutaneous involvement is rare. Wilson et al reviewed this subject and described such an instance.1 They could find only one previous case in the literature described by Guy and Jacob.2 Subsequently, three other cases of primary cutaneous disease have been reported.3-5 This report will summarize the findings in three additional individuals with primary cutaneous coccidioidomycosis.

Case 1.  —This 29-year-old white man, a laboratory technician, had been harvesting Coccidioidesimmitis for four months. Two weeks before hospitalization, he received a thorn puncture wound in the right fifth finger while on a picnic. One week later he noted a small accumulation of pus in the wound, which