Coccidioides is a dimorphic fungus that can cause various clinical presentations, mainly pulmonary, skin, musculoskeletal, and in the central nervous system; most reports are in the southwestern area of the USA. We present a case of a young male with a perianal abscess in the absence of any pulmonary or constitutional symptoms. Perianal abscess as initial manifestation is a novel presentation of coccidioidomycosis in the literature.