An otherwise healthy 63-year-old man had severe left epididymitis that was unresponsive to antibiotics, anti-inflammatory agents, a scrotal supporter, and rest.
With the exception of nodular induration, enlargement, and tenderness of the left epididymis, the patient’s physical examination and urinalysis were normal. Scrotal ultrasonography demonstrated a 3-mm right spermatocele and irregular echogenicity of the left epididymis. His history included mild, self-limited coccidioidomycosis pneumonia that had resolved without antifungal treatment 5 years earlier.
A left epididymectomy was performed, which revealed coccidioidomycosis (Figures 1A and 1B). Postoperatively, a search for recurrent disseminated disease was negative, and a cocci skin test was nonreactive. The coccidioidal IgG complement fixation titer was positive at 1:32 dilution (normal, negative titer). Oral fluconazole was prescribed, 600 mg, to be taken each
morning
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