Nodular fasciitis is a reactive proliferation of fibroblasts/myofibroblasts characterized by a rapidly growing non-tender subcutaneous mass and subsequently self-limited course. It is commonly found on the upper extremities, face, and shoulder, although it may occur in any superficial location. Its etiology is largely unknown, but associations have been made with local trauma, infection and inflammation. We report a case of an intraneural and intramuscular nodular fasciitis presenting in the obturator nerve and gracilis muscle, respectively. To our knowledge, this is the second reported case of this disease presenting in a nerve of the lower extremity, as well as the first reported case of it presenting within muscle and nerve simultaneously.

Primary coccidioidal infection caused by inhalation of spores growing several inches below the surface of desert soil in the San Joaquim valley in southern Arizona and central California is well documented in the literature. Most infections resolve quickly with minimal symptoms, although some individuals develop a subacute process called “Valley Fever”, which is characterized by shortness of breath, chest pain, cough and fevers lasting from weeks to months. Skin manifestations, including erythema nodosum and erythema multiforme may also be present and generally resolve with resolution of the respiratory tract illness. A recent retrospective study found that 6003 adult and 332 pediatric patients were hospitalized with endemic mycosis in 2002, but the overall incidence has been estimated at about 150,000 infections per year. We report a unusual case of recurrent stroke temporally associated with a CNS Coccidiomycosis infection in a traveler to a region where the fungus is endemic.