The answer is (D) Coccidioidomycosis:
This patient’s symptoms and history of travel to the southwestern United States are highly suggestive of coccidioidomycosis, also known as Valley Fever. This fungal infection is endemic to soil in areas like California, Arizona, Nevada, New Mexico, and Texas. It typically presents with symptoms of fever, cough, rash, including erythema nodosum, and can show features such as bilateral hilar adenopathy and diffuse reticulonodular infiltrates on chest X-ray. Eosinophilia is also a common laboratory finding in this infection.
Incorrect Answers: A) Tuberculosis could present with similar pulmonary symptoms and hilar adenopathy, but it is less likely to cause erythema nodosum or be associated with eosinophilia, and it generally does not have a clear association with recent travel to the southwestern U.S.
B) Acute histoplasmosis could cause similar symptoms and is endemic to the central United States, particularly along the Ohio and Mississippi River valleys, not the southwestern U.S. It is also less likely to produce erythema nodosum.
C) Blastomycosis is endemic to the southeastern and south-central United States, including areas around the Mississippi and Ohio River basins. It typically presents with pulmonary symptoms but is less likely to cause erythema nodosum or eosinophilia.
E) Sarcoidosis could present with bilateral hilar lymphadenopathy and pulmonary infiltrates, and it might also cause erythema nodosum. However, it is not associated with eosinophilia and lacks the acute presentation seen in this patient’s case.
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