Valley fever or coccidioidomycosis is a pulmonary infection caused by several species of coccidi-oides (Cocci) fungi that is endemic to California and Arizona. Skeletal coccidioidomycosis ac-counts for about half of disseminated infections, with the vertebral spine being the preferred site of dissemination. Most cases of skeletal coccidioidomycosis progress to bone destruction or spread to adjacent structures such as joints, tendons, and other soft tissues causing significant pain and restricting mobility. Manifestations of such cases are usually non-specific, making di-agnosis very challenging, especially in non-endemic areas. In this review, we explore case reports of dissemination of coccidioidomycosis to bones and/or joints to highlight key differential fea-tures with other conditions or diseases and highlight opportunities for mechanistic and pre-clinical studies that can help improve diagnostics, prognostics, and treatments.