I've only diagnosed one case of coccidioidomycosis, and it was on a small tropical island. Black male in his early 20s. Looked for all the world like a cutaneous lymphoma. Biopsy was full of granulomas and I got a fungal stain reflexively. We were all flabbergasted. Turns out the young man was from the Central Valley.
I note the patient's sex and race because it seems this particular group either has a particular tolerance for the disease until it's metastatic, or has a particularly aggressive reaction to metastatic disease. In either case, my ID colleagues tell me that when they present, they seem to present with markedly worse systemic disease. Don't take my word for it, here's the Mayo Clinic, reviewing many other studies over decades: