Immune Reconstitution Inflammatory Syndrome Presenting as Superior Vena Cava Syndrome Secondary to

A 39-year-old man living with AIDS presented with a swollen face. He was found to be HIV infected after pre-senting with Coccidioides pneumonia 2 years previously and was placed on daily fluconazole and then on highly active antiretroviral therapy. Computed tomography confirmed superior vena cave obstruction secondary to lymphadenopathy. Biopsy confirmed coccidioidomycosis with no evidence of malignancy. To our knowledge, this is the first description of superior vena cave syndrome secondary to coccidioidomycosis and the first description of immune reconstitution inflammatory syndrome involving Coccidioides