Abstract
Coccidioidomycosis osteomyelitis is a rare entity considered even more rare when identified in the immunocompetent patient. In non-endemic areas, the diagnosis of a fungus-causing osteomyelitis is often delayed or overlooked. This results in delayed or inappropriate treatment. We present the case of a 35-year-old immunocompetent male immigrant from India who was ultimately diagnosed as having Coccidioidomycosis immitis osteomyelitis of his ring finger metacarpal. His initial surgery included drainage and bacterial cultures only. When he failed to improve, he presented for a second opinion. The patient’s origin and travel history coupled with the appearance of rapid bone destruction on plain radiographs prompted a second operation for tissue biopsy and culture for bacteria, fungus, and mycobacteria cultures. This case highlights the importance of a thorough clinical history in deriving an appropriate differential diagnosis prior to surgical intervention.
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References
al-Qattan M. Opportunistic mycotic infections of the upper limb. A review. J Hand Surg (Br). 1996;21:148–50.
Bried JM, Galgiani JN. Coccidioides immitis infections in bones and joints. Clin Orthop Relat Res. 1986; 235–243.
Cassone A, Casadevall A. Recent progress in vaccines against fungal diseases. Curr Opin Microbiol. 2012;15:427–33.
Cole GT, Hurtgen BJ, Hung CY. Progress toward a human vaccine against coccidioidomycosis. Curr Fungal Infect Rep. 2012;6:235–44.
Cortner JW, Schwartzmann JR. Bone lesions in disseminated coccidiodomycosis. Ariz Med. 1957;14:401–4.
Crum NF, Lederman ER, Stafford CM, et al. Coccidioidomycosis: a descriptive survey of a reemerging disease. Clinical characteristics and current controversies. Med (Baltim). 2004;83:149–75.
Deresinski SC. Coccidioidomycosis: efficacy of new agents and future prospects. Curr Opin Infect Dis. 2001;14:693–6.
Desai SA, Minai OA, Gordon SM, et al. Coccidioidomycosis in non-endemic areas: a case series. Respir Med. 2001;95:305–9.
Dewsnup DH, Galgiani JN, Graybill JR, et al. Is it ever safe to stop azole therapy for Coccidioides immitis meningitis? Ann Intern Med. 1996;124:305–10.
Fiese MJ. Coccidioidomycosis. Springfield: Charles C. Thomas; 1958.
Galgiani JN, Catanzaro A, Cloud GA, et al. Comparison of oral fluconazole and itraconazole for progressive, nonmeningeal coccidioidomycosis. A randomized, double-blind trial. Mycoses Study Group. Ann Intern Med. 2000;133:676–86.
Hirschmann JV. The early history of coccidioidomycosis: 1892-1945. Clin Infect Dis. 2007;44:1202–7.
Ho L, Schnall S, Schiller F, et al. Metacarpal coccidioidal osteomyelitis. Am J Orthop (Belle Mead NJ). 2011;40:34–6.
Holley K, Muldoon M, Tasker S. Coccidioides immitis osteomyelitis: a case series review. Orthopedics. 2002;25:827–2.
Huntington RW. Pathology of coccidioidomycosis. In: Stevens DA, editor. Coccidioidomycosis: a text. New York: Plenum Medical Book Co.; 1980. p. 113.
Kirkland TN, Fierer J. Coccidioidomycosis: a reemerging infectious disease. Emerg Infect Dis. 1996;2:192–9.
Lammering JC, Iv M, Gupta N, et al. Imaging spectrum of CNS coccidioidomycosis: prevalence and significance of concurrent brain and spinal disease. AJR Am J Roentgenol. 2013;200:1334–46.
Pappagianis D, Lindsay S, Beall S, et al. Ethnic background and the clinical course of coccidioidomycosis. Am Rev Respir Dis. 1979;120:959–61.
Prabhu RM, Bonnell M, Currier BL, et al. Successful treatment of disseminated nonmeningeal coccidioidomycosis with voriconazole. Clin Infect Dis. 2004;39:e74–7.
Rhangos WC, Chick EW. Mycotic infections of bone. South Med J. 1964;57:664–74.
Sandoval JJ, Shank JR, Morgan SJ, et al. Midfoot coccidioidal osteomyelitis. A case report and review of the literature. J Bone Joint Surg Am. 2006;88:861–5.
Sheppard JE, Switlick DN. Coccidioides immitis osteomyelitis of the radius presenting as Ewing’s sarcoma. Orthopedics. 2008;31:607.
Stevens DA. Coccidioidomycosis. N Engl J Med. 1995;332:1077–82.
Tan LA, Kasliwal MK, Nag S, et al. Rapidly progressive quadriparesis heralding disseminated coccidioidomycosis in an immunocompetent patient. J Clin Neurosci. 2014;21:1049–51.
Conflict of Interest
Jens U. Berli declares that he has no conflicts of interest.
Wayne N. Campbell declares that he has no conflicts of interest.
Ryan D. Katz declares that he has no conflicts of interest.
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Berli, J.U., Campbell, W.N. & Katz, R.D. Coccidioidomycosis causing osteomyelitis of the hand in an immunocompetent patient. HAND 10, 562–564 (2015). https://doi.org/10.1007/s11552-014-9696-9
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DOI: https://doi.org/10.1007/s11552-014-9696-9