The dimorphic fungus Coccidioides immitis is endemic to regions of the southwestern United States, Mexico, and Central America. The mycelial form is highly infectious and is carried in dust, which is inhaled. The lung is primarily affected. The disease caused by this organism ranges from an asymptomatic form to the disseminated or progressive type. Diagnosis hinges on identification of fungal infection by means of biopsy, culture, serology, or skin testing. Each method has advantages and pitfalls. This report discusses a case of granulomatous lymphadenitis caused by C immitis which was diagnosed in the eastern United States by means of a lymph node biopsy.