Coccidioidomycosis Osteoarticular Dissemination

A man in his 50s with a history of psoriasis was evaluated for acute on chronic left ankle pain. His symptoms were attributed to psoriatic arthritis, and he tried several immunosuppressive regimens without improvement. Further diagnostic workup confirmedCoccidioides immitis/posadasiiseptic monarthritis thought secondary to a known remote history of Valley fever while residing in Arizona and subsequent reactivation in the setting of immunosuppression. The patient ultimately required prolonged anti-fungal therapy and multiple surgical debridements.Although psoriatic arthritis can present as monarthritis, it is uncommon, with more likely differential considerations including crystal arthropathies, trauma and both typical and atypical infections. Acute monarthritis should always prompt concern for a septic joint, even in a patient with autoimmune disease. The specific history elicited from the patient, including residence in an endemic region, and known priorCoccidioidesinfection, increased suspicion forCoccidioidesand led to the correct diagnosis and management.

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Evolutive radiological findings in an exceptional case of Cryptococcal and Coccidioidal co-infection in an immunocompetent male. A case report.

Montanara,

Albergo,

Castellana

et al. 2024

Preprint

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Background: Bone infections such as chronic fungal erosive osteomyelitis are rare. uncommon forms of bone infection. The widespread yeast of the Cryptococcus species, the endemic dimorphic fungus Coccidioides, and the simultaneous infection by multiple pathogen species are even less common, especially in immunocompetent hosts. These infections frequently have no symptoms and the clinical signs remain undetected, allowing the infection to worsen over weeks or months. Mycotic arthritis is one of the rarest clinical symptoms; it is hard to distinguish from other types of arthritis, which slows down the diagnosis procedure. Case presentation: In order to demonstrate the beginning and progression of radiological abnormalities in a case of aggressive fungal osteomyelitis, we provide the case of a 31-year-old male patient here. The man showed signs of extensive bone erosion and inflammatory involvement in his right knee and right hallux phalanx, although he had no prior history of immunodeficiency. The co-infection resulting from Cryptococcus Neoformans in his right knee and Coccidioides Immitis in his hallux were the reason for the injuries. Conclusions: While an acute, benign, and self eradicating lung infection is the predominant presentation for most cases of cryptococcosis and coccidioidomycosis, a small percentage of patients experience a devastating extrapulmonary condition, which can include arthritis. The pathogenic mechanism of bone involvement are unknown, and it often remains untreated. Here, we discuss radiographic evidence of particular bone inflammation during the early phase and later phases of the disease, since management of this chronic condition remains a challenge. We propose that imaging may mimic osseous neoplasia in persistent fungal diseases, such as Coccidioidomycosis and Cryptococcosis.

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Coccidioidomycosis Osteoarticular Dissemination

Cited by 4 publications

References 109 publications

Rare Cause of Cervical Radiculopathy

Rare Cause of Cervical Radiculopathy

Coccidiomycosis septic arthritis presenting as ankle monoarthritis in a patient with presumed psoriatic arthritis

Evolutive radiological findings in an exceptional case of Cryptococcal and Coccidioidal co-infection in an immunocompetent male. A case report.

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