Pulmonary mycetoma due to Coccidioides immitis has been reported on three occasions. The present case is the fourth such report occurring in a patient with widely disseminated disease. Spherules and hyphae were found in the specimen. While the active pulmonary and extra-pulmonary lesions responded well to therapy with amphotericin B, resection was required to eliminate the residual mycetoma and its attendant hemoptysis.