A patient with disseminated coccidioidomycosis with acute palmar tenosynovitis is presented. Early synovectomy followed by amphotericin B therapy was carried out and is recommended for treatment of coccidioidomycosis tenosynovitis. The association of an exacerbation of coccidioidomycosis in a patient with a history of coccidioidomycosis treated with immunosuppressive drugs is described. Prophylactic amphotericin B therapy is recommended for such patients.