A 55-year-old man from Arizona with four weeks of fever, night sweats, dry cough, weight loss, and myalgia most likely has which infection?

A 55-year-old man from Arizona with four weeks of fever, night sweats, dry cough, weight loss, and myalgia most likely has which infection?

• A. Valley Fever (coccidioidomycosis)
• B. Tuberculosis
• C. Pneumococcal pneumonia
• D. Sarcoidosis

Answer: (A)

Valley Fever (coccidioidomycosis) is the most likely diagnosis because the patient’s presentation fits a subacute pulmonary infection acquired in the desert Southwest. Coccidioides fungi are endemic to Arizona, and inhalation of the organism often produces fever, dry cough, night sweats, weight loss, and myalgias over several weeks. The geographic clue is a strong driver here and helps distinguish it from other causes. Tuberculosis can also cause fever, night sweats, and weight loss, but while possible, it isn’t as region-specific and the subacute, flu-like pulmonary picture is more characteristic of Valley Fever in this setting. Pneumococcal pneumonia usually presents acutely with a productive cough and lobar consolidation, not a dry cough with a longer, gradual course. Sarcoidosis would be noninfectious and less likely to cause this infectious-style presentation in this geographic context.

Valley Fever (coccidioidomycosis) is the most likely diagnosis because the patient’s presentation fits a subacute pulmonary infection acquired in the desert Southwest. Coccidioides fungi are endemic to Arizona, and inhalation of the organism often produces fever, dry cough, night sweats, weight loss, and myalgias over several weeks. The geographic clue is a strong driver here and helps distinguish it from other causes.

Tuberculosis can also cause fever, night sweats, and weight loss, but while possible, it isn’t as region-specific and the subacute, flu-like pulmonary picture is more characteristic of Valley Fever in this setting. Pneumococcal pneumonia usually presents acutely with a productive cough and lobar consolidation, not a dry cough with a longer, gradual course. Sarcoidosis would be noninfectious and less likely to cause this infectious-style presentation in this geographic context.