A review of four cases of disseminated coccidioidomycosis involving the spine shows a variety of radiographic manifestations. Classic features of coccidioidal spondylitis include multiple spinal foci with preservation of disk spaces and indiscriminate involvement of the vertebral bodies and appendages. There are often associated paraspinous soft-tissue masses without gibbous deformity of the spine. In this series, the unusual manifestations of coccidioidal spondylitis include gibbous deformity, cystic lesions of the vertebral bodies, and sclerosis. An unusual pattern of healing of coccidioidomycosis is shown in one case.