Coccidioidomycosis, although endemic to southwest regions of United States, has sporadic cases which can be encountered outside of the endemic areas. Clinicians must be aware of usual and unusual presentations of this disease entity and should keep a high level of suspicion for the diagnosis. We discuss an uncommon presentation for pulmonary coccidioidomycosis in a patient with a history of HIV/AIDS, who presented with pneumothorax due to a ruptured coccidioidal cavity. This report also illustrates the high importance of travel history in investigating rare disease presentations.