The fungus that causes Valley fever is found in much of the United States.


A rare fungal disease was the cause of a 34-year-old man’s frightening tongue lesion featured in a new case report.

The patient went to the emergency room and told doctors he’d experienced fever, headaches, and confusion for the last week or so. “On physical examination a large, ulcerative lesion was noted on his tongue,” the new case report from the New England Journal of Medicine says.

The patient had HIV, and doctors noted that his CD4 count was low. CD4 cells are infection-fighting white blood cells, and a patient’s CD4 count, also known as their T-cell count, lets doctors know how well their immune system is functioning. (The higher your CD4 count, the better off you are.)

A normal range for a CD4 count is about 500 to 1,500 cells per cubic millimeter. The patient featured in the case report, however, had a CD4 count of just 39.

disseminated-coccidioidomycosis tongue mouth infection health virus bacteria condition wellbeing
Credit: NEJM

Doctors ordered a biopsy of the man’s tongue lesion, which found “multiple fungal organisms consistent with coccidioides sphereles,” the new report says. Coccidioidomycosisis a fungal disease that’s caused by two fungi: Coccidioides immitis and C. posadasii.

This type of infection is also known as Valley fever. The fungi that cause Valley fever can be found in soil in the southwestern United States, parts of Central and South America, and Mexico. It was recently found as far north as south-central Washington, according to the CDC.

How do you get Valley fever? “By breathing in the microscopic fungal spores from the air,” the CDC says.

Symptoms of Valley fever include fever, cough, fatigue, headache, shortness of breath, night sweats, joint pains or muscle aches, and a rash on the legs or upper body. Symptoms of the disease can appear within one to three weeks after inhalation of the fungal spores.

It’s important to note that most people who inhale the spores that can cause Valley fever don’t fall ill. The CDC says that anyone who travels to or lives in Arizona, California, New Mexico, Nevada, Utah, or Texas—or the parts of Central and South America where the spores are found—is at risk for developing Valley fever.

But people older than 60, and people with weakened immune systems, including people with HIV, have an increased risk. Black, Filipino, diabetic, and pregnant individuals are at an increased risk.

The unlucky individuals who do get sick after breathing in the fungal spores will usually get better without treatment within weeks to months. However, some will need antifungal medication.

The patient featured in the new case report was treated with antifungal medication, and after three months, his fever and headache “had resolved [and] the tongue lesion had decreased in size,” the case report said.

While Valley fever goes away on its own for most, it can develop into something more serious. The CDC says that up to 10% of those who get Valley fever “develop serious or long-term problems in their lungs.” For about 1% of people who get the disease, the infection travels from their lungs to additional body parts, such as the skin, bones and joints, or central nervous system.

The CDC says that it’s difficult to avoid breathing in the fungi that cause Valley fever if you’re in an area where the fungi are found. If you are traveling to the southwest United States, you should take care to avoid especially dusty areas when possible. Additionally, the CDC says installing indoor air filtration systems might lower your chances of developing Valley fever.

It’s important to note that some Valley fever symptoms mimic allergy symptoms. If you believe you’re struggling with seasonal allergies, but your symptoms don’t go away, you should consider speaking with your doctor about them.