Complications and Management of a Rare Case of Disseminated Coccidioidomycosis to the Vertebral Spine

Abstract

Coccidioidomycosis, also known as San Joaquin Valley Fever or Valley Fever, is mostly a pulmonary infection caused by inhalation of spores in an endemic region. Dissemination to bone, joints, meninges, and skin occurs less than one percent of the time. Skeletal involvement accounts for approximately half of the disseminated coccidioidomycosis with the vertebrae as the most common skeletal region. We present a very rare case of disseminated coccidioidomycosis with osteomyelitis and compression fracture of the lumbar vertebral body. This case depicts some of the potential issues that can arise in managing coccidioidomycosis, especially when noncompliance to initial azoles occurs, that can lead to dissemination and complicated bone infections necessitating surgical intervention along with continuous medical therapy.

Nanomaterial-Based Antifungal Therapies to Combat Fungal Diseases Aspergillosis, Coccidioidomycosis, Mucormycosis, and Candidiasis

“…In Mexico, a meningeal coccidioidomycosis clinical case was treated with AmBisome for nine months and no liver or kidney toxicity data were reported [130]. Furthermore, AmBisome has been employed in combination with azoles in a rare case of disseminated coccidioidomycosis (with osteomyelitis and compression of the lumbar vertebral body) [131]. Clemons et al (2009) compared the efficacy of Abelcet and AmBisome in coccidioidal meningitis caused by Coccidioides posadasii in rabbits.…”

“…[132,133] Liposomal amphotericin B (L-AmB, AmBisome ® ) Successfully used as an alternative and safe option of treatment. [128][129][130][131]133] Amphotericin B colloidal dispersion (ABCD, Amphotec ® /Amphocil ® )…”

Therapies and Vaccines Based on Nanoparticles for the Treatment of Systemic Fungal Infections

“…After 30 days of infection, BALB/c mice were treated with 6 mg/kg Nano-D-AMB at 72 h intervals. Treated mice had reduced body weight loss, absence of stress (piloerection and hypotrichosis) and renal or hepatic González et al, 2002 Liposomal (AmBisome) AmB C. immitis In vivo (human) Antony et al, 2003;Rangel et al, 2010;Nakhla, 2018;Sidhu et al, 2018 In vivo (rabbits) Clemons et al, 2002 C. posadasii In vivo (rabbits) Clemons et al, 2009 Coccidiodes spp.…”

“…In addition, AmBisome® has been successful in treating disseminated coccidioidomycosis in patients undergoing steroid therapy (Antony et al, 2003 ). It was employed in case of rare dissemination to the spine that required surgical intervention, being associated with continuous therapy with other azoles (Nakhla, 2018 ).…”

(Ig)Easy diagnosis of disseminated coccidioidomycosis

“…Both of them are associated with similar presentations 3. The former is found in California, commonly known as Valley fever and the latter is endemic to other parts of the USA and Mexico4–6 (figure 1). This dimorphic fungus is found in warm wet soil and can cause fungal infection through inhalation when spores are scattered through the wind, especially during earthquakes and dust storms 2 3.…”