This report describes an unusual presentation of a man with a testicular mass who presented in diabetic ketoacidosis to the emergency department. Initial diagnosis was a suspected testicular malignancy based on history, physical exam, and available laboratory and radiological imaging. Due to the possibility of a testicular malignancy, the patient was taken for immediate orchiectomy. Histology revealed coccidioido-mycosis of the left testicle and epididymis. Treatment with the appropriate antifungals was initiated. Despite aggressive multi-disciplinary therapy the patient continued to deteriorate and eventually expired as a result of the massive systemic infection. Literature review revealed the presentation of disseminated genitourinary coccidioidomycosis is rare and seldom reported.