A Case of Disseminated Coccidioidomycosis Presenting as Ascites in a Previously Healthy Middle-Aged Man

We present a rare case of disseminated coccidioidomycosis in a previously healthy 47-year-old man with peritoneal involvement causing ascites. Diagnosis relied on serology and lung tissue histopathology with fungal culture. A large-volume paracentesis and initial fluconazole treatment resolved ascites and stabilized pulmonary lesions. However, relapse after discontinuation of treatment required dose escalation, leading to clinical and serologic improvement. This case expands clinical awareness of atypical presentations of coccidioidomycosis while reviewing the literature on patient demographics and diagnostic work-up in the limited number of previously reported cases.