In Texas there are limited data on the epidemiology of coccidioidomycosis. Our goal is to determine the prevalence of coccidioidomycosis in a county hospital in El Paso, Texas. The charts of all patients with coccidioidomycosis admitted to the hospital in the past 9 years was retrospectively reviewed statistical analysis performed. Forty-one cases were identified, giving a prevalence of 3.2 cases per 10,000 discharges. Pneumonic consolidation occurred in 14 (44%), miliary pattern in 6 (19%) and cavitation in 6 (19%) cases. Pulmonary involvement occurred in 32 patients (78%) and meningeal involvement in 3 patients. Six patients had disseminated disease. The mortality rate was higher with disseminated disease (50% compared to 3.6%, P = 0.04). Four had concomitant pulmonary tuberculosis. Diabetes mellitus was found in 17 patients (41.4%), followed by HIV infection in 15 (36.5%). Patients with HIV had a higher incidence of disseminated disease (36.4% vs. 0%, P = 0.01). Four patients died, and the risk of death was increased in disseminated disease (P < 0.05). Coccidioiomycosis is not as frequent in El Paso, and for that matter in Texas, as in other states, but still has to be taken into consideration both in HIV and in diabetic patients.