# Atypical Pleural Effusion in an Immunocompetent Patient With Valley Fever: A Case Study and Review of the Literature

## TL;DR

A rare case of Valley fever in an immunocompetent man led to a persistent pleural effusion, highlighting the need to consider fungal infections in endemic regions.

## Contribution

This case study presents an unusual manifestation of coccidioidomycosis in an immunocompetent patient requiring surgical intervention.

## Key findings

- An immunocompetent patient developed a large pleural effusion due to Valley fever.
- The effusion did not resolve with standard treatment and required thoracic surgery.
- The case underscores the importance of considering Coccidioides in unresolved pneumonia in endemic areas.

## Abstract

Valley fever is a fungal infection, commonly of the lungs, caused by Coccidioides immitis or Coccidioides posadasii. This disease is endemic to the southwestern United States, Central America, and South America. Infected individuals are typically asymptomatic but may develop community-acquired pneumonia. On rare occasions, coccidioidomycosis can present with severe complications in addition to the pulmonary manifestation. In this study, a 58-year-old immunocompetent male presented to the Emergency Department with a cough, night sweats, and pleuritic chest pain. Despite the administration of broad-spectrum antimicrobials, he developed a large right pleural effusion that did not resolve following thoracentesis. Serology was positive for Coccidioides, and the patient was referred to a thoracic surgeon due to persistent effusion. It is rare for patients with coccidiomycosis to develop a large pleural effusion requiring surgical intervention, especially in immunocompetent individuals. This case highlights the importance of monitoring patients with unresolved acute pneumonia in endemic areas and considering Coccidioides as a possible etiology.