Valley fever or Legionnaires’ disease?

My doctor diagnosed me with pneumonia and treated me with azithromycin for five days. A week later, I showed up in his office with erythema nodosum on my lower legs. He decided to test me for Legionella (results were 1:256), Chlamydia pneumonia (IgG was 1:256) and coccidioidomycosis (+). Because the coccidioidomycosis result showed positive, he treated me with fluconazole (600 mg/day). A CT scan was taken which showed a small infiltrate in my upper right lob. Over the next five months, I slowly regained my health and the infiltrate calcified and decreased.  


My problem is that I’m not sure what I had because when my primary doc sent me to a pulmonologist, the pulmonologist said I never had cocci! He said I had Legionella pneumonia and that it is cured. My symptoms were night sweats, nausea, anxiety, pressure in my left lung area, sharp pain in my upper left shoulderblade, terrible fatigue and slight hematuria for 3 months. Is it possible that I had Legionella and not Valley Fever (coccidioidomycosis)?

  1. Does Legionella cause infiltrates that calcify?
  2. Does Legionella cause erythema nodosum?
  3. Does Legionella cause the other symptoms I experienced? 


  1. No, but Valley Fever commonly causes calcifications.
  2. It is rare in Legionnaires’ disease, and not uncommon for Valley Fever.
  3. Legionella causes acute pneumonia which generally requires hospitalization. What was the exact serologic test performed for coccidioidomycosis? The coccidioidomycosis serology performed before IgM antibody has a relatively high false positive rate, while the IgG antibody is more specific. I believe you more likely had Valley Fever (coccidioidomycosis).