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

ABSTRACT 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.