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This case report discusses a 39-year-old male with advanced HIV infection presenting with fever, weight loss, and respiratory symptoms, ultimately succumbing to fulminant pulmonary coccidioidomycosis. Despite initial empirical treatment for bacterial pneumonia and Pneumocystis jirovecii, the patient's condition rapidly deteriorated, highlighting the diagnostic challenges posed by this fungal infection, especially in immunocompromised individuals. Diagnostic confirmation was complicated by nonspecific clinical features, overlapping symptoms with other opportunistic infections, and unreliable serological tests. Radiological findings resembled those of other pulmonary infections, further complicating timely diagnosis. Delayed recognition of disseminated coccidioidomycosis contributed to the patient's poor prognosis. Antifungal therapy, primarily azoles, remains the cornerstone of management, with prognosis worsening with additional dissemination sites and advanced HIV illness. This case underscores the importance of considering pulmonary coccidioidomycosis in immunocompromised patients presenting with respiratory symptoms, particularly in endemic regions.