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Culture-confirmed cutaneous disease, positive serology, and imaging demonstrated pulmonary and central nervous system (CNS) involvement, establishing the diagnosis. The patient achieved marked clinical improvement with high-dose oral fluconazole (800\u2009mg, later tapered to 400\u2009mg daily), with serial imaging documenting resolution of CNS and pulmonary lesions. Lymphocyte subset analysis revealed preserved immune function with subtle findings suggestive of age-related immunosenescence. This case demonstrates that DCM can occur in elderly patients without traditional immunocompromise and emphasises the importance of maintaining high clinical suspicion in endemic areas.<\/jats:p>","DOI":"10.1136\/bcr-2025-269449","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T19:40:30Z","timestamp":1766518830000},"page":"e269449","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Disseminated coccidioidomycosis with cutaneous, pulmonary and suspected CNS involvement in an elderly patient with Parkinson\u2019s disease"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5106-1039","authenticated-orcid":false,"given":"Ricardo","family":"Villanueva Gaona","sequence":"first","affiliation":[{"name":"Dermatology, Stanford University School of Medicine, Stanford, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danny","family":"Linggonegoro","sequence":"additional","affiliation":[{"name":"Dermatology, Stanford University School of Medicine, Stanford, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9628-3610","authenticated-orcid":false,"given":"Mariana","family":"Ramirez Posada","sequence":"additional","affiliation":[{"name":"Dermatology, Stanford University School of Medicine, Stanford, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Yuh","family":"Tang","sequence":"additional","affiliation":[{"name":"Dermatology, Stanford University School of Medicine, Stanford, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"2025122311402069000_18.12.e269449.1","doi-asserted-by":"crossref","first-page":"i40","DOI":"10.1093\/jac\/dkaf002","article-title":"Coccidioidomycosis: a growing global concern","volume":"80","author":"Donovan","year":"2025","journal-title":"J Antimicrob Chemother"},{"key":"2025122311402069000_18.12.e269449.2","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S34434"},{"key":"2025122311402069000_18.12.e269449.3","doi-asserted-by":"publisher","DOI":"10.1086\/496991"},{"key":"2025122311402069000_18.12.e269449.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199504203321607"},{"key":"2025122311402069000_18.12.e269449.5","doi-asserted-by":"crossref","first-page":"666","DOI":"10.3390\/jof8070666","article-title":"Update on the Epidemiology, Diagnosis, and Treatment of Coccidioidomycosis","volume":"8","author":"Williams","year":"2022","journal-title":"JoF"},{"key":"2025122311402069000_18.12.e269449.6","doi-asserted-by":"publisher","DOI":"10.1136\/jim-2020-001655"},{"key":"2025122311402069000_18.12.e269449.7","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1007\/s40121-022-00606-y","article-title":"Coccidioidomycosis: A Contemporary Review","volume":"11","author":"Crum","year":"2022","journal-title":"Infect Dis Ther"},{"key":"2025122311402069000_18.12.e269449.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2008.12.024"},{"key":"2025122311402069000_18.12.e269449.9","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1056\/NEJMra2306821","article-title":"Coccidioidomycosis and Histoplasmosis in Immunocompetent Persons","volume":"390","author":"Galgiani","year":"2024","journal-title":"N Engl J Med"},{"key":"2025122311402069000_18.12.e269449.10","unstructured":"California Department of Public Health . 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