We report the case of a 16-year-old female with genetic immunodeficiency in whom pulmonary coccidioidomycosis became disseminated. Most infections due to Coccidioides immitis are self-limited and resolve over a period of weeks to months without specific treatment. In rare cases, especially those associated with immunodeficiency, the disease is found outside the confines of the chest cavity. In these cases, the most common site of dissemination is the skin. Defining the extent of dissemination often relies on diagnostic imaging.