Musculoskeletal and CNS coccidiomycosis in an individual with multiple sclerosis on fingolimod - A case report.

We report the case of a 56-year-old female with a past medical history of multiple sclerosis on disease-modifying therapy of fingolimod who presented with disseminated Coccidioides infection, initially of the ankles bilaterally before progressing to the central nervous system. CNS coccidiomycosis has thus far not been associated with any pharmacological therapy for multiple sclerosis. Clinicians should have a high degree of suspicion for Coccidioides infection in immunosuppressed patients living in endemic areas.