Unexpected laboratory diagnosis of latent urogenital coccidioidomycosis in a nonendemic area.

Dissemination of coccidioidomycosis beyond the respiratory tract is not uncommon, but involvement of the urogenital tract is rarely observed. Most, if not all, reported cases of urogenital infections caused by Coccidioides immitis have been diagnosed in areas considered endemic for the fungus, where suspicion of this illness and its extrapulmonary manifestations is high. In nonendemic regions, however, C immitis is not likely to be considered as a possible cause of genitourinary tract infections unless the organism is fortuitously identified by histologic, cultural, or serologic studies. We report the unexpected isolation of C immitis from routine bacterial cultures of a draining urethral-scrotal fistula from a patient residing in a nonendemic area of the United States. We also discuss the difficulties and potential hazards encountered during the laboratory evaluation of this case.