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Coccidioidomycosis (valley fever) is caused by the dimorphic fungi  Coccidioides immitis  or  Coccidioides posadasii . Most infections are asymptomatic or result in self-limited pneumonia; extrapulmonary dissemination via either hematogenous or lymphatic spread is rare. Here, we present a case of cervical  C. immitis  lymphadenitis that resulted in fistula formation to the esophagus via mediastinal extension. This case highlights a very unusual extrapulmonary manifestation of coccidioidomycosis, the difficulty in diagnosing coccidioidal infection when it is not suspected, and the importance of obtaining a thorough exposure history to assist with diagnosis.

Coccidioides immitisCervical Lymphadenitis Complicated by Esophageal Fistula