Pulmonary coccidioidomycosis is an infection in the lungs caused by the fungus Coccidioides. The disease is very rare in India and only a few cases have been reported so far. The diagnosis of pulmonary coccidioidomycosis is very challenging because it mimics other lower respiratory tract infections. Both clinical suspicion and laboratory confirmation plays a very important role in the diagnosis of this infection and in resource limited settings only culture and microscopy play a vital role in the diagnosis. We present a case of 57 years old, agriculturist and a known case of IHD, presented with pleural infection which was clinically diagnosed as tuberculosis which was later confirmed as pulmonary coccidioidomycosis. Early diagnosis helps in appropriate therapy to avoid later complications.