An unusual case of stroke and fevers in a traveler returning from Arizona.

growing several inches below the surface of desert soil in the San Joaquim valley in southernArizona and central California is well documented in the literature. Most infections resolve quickly with minimal symptoms,1 although some individuals develop a subacute process called “Valley Fever”, which is characterized by shortness of breath, chest pain, cough and fevers lasting from weeks to months. Skin manifestations, including erythema nodosum and erythema multiforme may also be present and generally resolve with resolution of the respiratory tract illness. A recent retrospective study found that 6003 adult and 332 pediatric patients were hospitalized with endemic mycosis in 2002,2 but the overall incidence has been estimated at about 150,000 infections per year. We report a unusual case of recurrent stroke temporally associated with a CNS Coccidiomycosis infection in a traveler to a region where the fungus is endemic.