Coccidioidal osteomyelitis of a metatarsal

Mishra, Debasish; Mohanty, Atanu

doi:10.1007/bf00186870

Cited by 5 publications

(2 citation statements)

References 2 publications

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“…14,15 Although the geographic range of endemicity of coccidioidomycosis is rather limited, it is well recognized that it can be encountered in nonendemic areas of the United States and overseas, 16 including cases involving bones and joints. 7,12,[17][18][19] Importantly, the incidence of coccidioidomycosis has also risen sharply elsewhere in the United States in recent years, with the number of reported cases in nonendemic states increasing rapidly from 4 in 1998 to 240 in 2011, 20 likely fueled at least in part by the popularity of these regions as tourist and business destinations and ease of international airline travel. This incidence, although still relatively low, nonetheless surpasses the incidence of many uncommon neoplasms with which pathologists are required to be familiar, despite their rarity.…”

Section: Discussionmentioning

confidence: 99%

Surgical Pathology of Skeletal Coccidioidomycosis

Ricciotti

Shekhel

Blair

et al. 2014

American Journal of Surgical Pathology

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Skeletal coccidioidomycosis is a rare complication of pulmonary coccidioidomycosis that remains incompletely characterized, and its histopathologic features have not been systematically evaluated. All skeletal coccidioidal infections (2000 to 2012) were retrieved from the University of Arizona and Mayo Clinic in Arizona pathology archives. Clinical history and histologic features were reviewed. Among 25 patients (median age 40 y; 17 men), infections involved bones (2 cases), joints (6), or both (17), usually in the distal extremities (68%), especially the wrist (32%). History included previously documented coccidioidomycosis (13), autoimmune disease (8), diabetes (6), malignancy (4), and iatrogenic immunosuppression (10). Common symptoms (median 3 mo) included pain/arthralgia (21) and swelling (10). Cultures and serology were positive in 15 of 17 (88%) and 19 of 22 patients (86%), respectively. Treatment included surgical debridement(s) and chronic antifungal medication(s). Histologic review showed granulomas in all cases, ranging from poorly to well formed, with or without necrosis. Spherule density varied widely (mean 4.8/HPF; range <0.1 to 13.5/HPF). Composition of inflammatory infiltrates, degree of necrosis, and extent of fibrosis did not significantly differ between immunocompetent and immunocompromised patients. Eosinophils were only seen in one third of cases; when present, eosinophils were almost always rare. 10 patients experienced recurrent infection, 8 of whom were immunocompromised; the remaining patients recovered. In conclusion, distal extremities are the most common sites of skeletal coccidioidomycosis encountered by surgical pathologists. This condition is strongly associated with autoimmune disorders and immunosuppression. Spherules are sometimes rare, and multiple modalities including serology, culture, and histology may be required for diagnosis.

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Section: Discussionmentioning

confidence: 99%

Surgical Pathology of Skeletal Coccidioidomycosis

Ricciotti

Shekhel

Blair

et al. 2014

American Journal of Surgical Pathology

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“…Exposure to a lower desert area in the western hemisphere where the fungus is endemic, including southern Arizona, central California, southwestern New Mexico, and western Texas; also found in parts of Mexico and Central and South America Non-white race be involved 12,14,15 . Between 45% and 64% of bone coccidioidomycosis cases present with multiple bone involvement 8,12 .…”

Section: Risk Factors For Acquisitionmentioning

confidence: 99%