Coccidioidomycosis is a pulmonary fungal infection endemic to the southwestern United States and northern Mexico. Disseminated coccidioidomycosis occurs in 0.1-0.5% of cases and is a life-threatening condition. We report a case of disseminated coccidioidomycosis in an immunocompetent black male with cutaneous lesions, a flocculent neck mass, bilateral hilar adenopathy, persistent fever, night sweats and malaise. The clinical suspicion was lymphoma with cutaneous involvement. Fine needle aspiration (FNA) of the neck mass provided the primary diagnosis of coccidioidomycosis. It was confirmed by culture of FNA-obtained fluid and a subsequent biopsy of a cutaneous lesion. As shown in this case, FNA of soft tissue masses may provide rapid identification of the responsible organism and allow early initiation of therapy for this potentially life-threatening infection.