48-year-old patient, farmer, with hypertension treated with enalapril and amlodipine.
He came to the hospital with a lesion in the right nasal wing characterized by swelling, erythema, exulcerations and serous exudate, two cm in diameter and five years of evolution.
The diagnosis was confirmed by the presence of spherules in the direct examination and a positive culture to Coccidioides spp.
He was treated with itraconazole 400 mg daily.
