Palmar Rash in a Patient With Valley Fever Pneumonia: A Diagnostic Challenge

Coccidioidomycosis, also known as Valley Fever, is a fungal infection endemic to the southwestern United States.While the disease typically presents with limited pulmonary symptoms, extrapulmonary symptoms can also be present.In this case, an 84-year-old female developed palmar erythema following initiation of treatment with fluconazole for management of symptomatic pulmonary Coccidioidomycosis.On exam, the patient had bilateral palmar erythema that began improving a few weeks after initiation of treatment.It was ultimately resolved following a short course of steroids and completion of treatment with fluconazole.This case illustrates a rare, reactive palmar eruption occurring after the initiation of antifungal therapy for pulmonary coccidioidomycosis, underscoring its role as a great mimicker and the diagnostic challenge of paradoxical or reactive phenomena during treatment.