Musculoskeletal Coccidioidomycosis

Abstract

Coccidioidomycosis is a primary pulmonary infection, endemic to the southwestern United States, caused by inhalation of spores in an immunocompetent host. When systemic spread occurs, the dissemination of infection to musculoskeletal sites might account for 20% to 50% of cases. The musculoskeletal manifestations are well recognized by physicians in endemic areas. We report 2 cases encountered in metropolitan Chicago in which morphologically typical, large, yeast-like, encapsulated, endosporulating organisms were identified in tissue samples and Coccidioides immitis was cultured. One patient had a degenerative-type radiographic picture thought to be related to a sports injury. A second patient with skin lesions and a paraspinal mass required emergency decompressive spinal surgery. A history consistent with exposure to Coccidioides organisms was apparent only for the first patient. Although the diagnosis can be established morphologically by identifying the large endospores in tissue samples, the submission of samples for culture and subsequent microbiologic confirmation requires the diagnosis to be considered clinically. This report emphasizes the rarity of the organism in nonendemic areas and the redundant value of using both morphologic and microbiologic modalities.

Coccidiomycosis infection of the patella mimicking a neoplasm – two case reports

“…The incidence is increasing, not only in immunocompromised patients but also among healthy persons [1]. In some series it even accounts for 20% to 50% of disseminated cases [7]. The knee and the spine are the most commonly affected musculoskeletal sites [7-9,12].…”

“…In some series it even accounts for 20% to 50% of disseminated cases [7]. The knee and the spine are the most commonly affected musculoskeletal sites [7-9,12]. Often, fungal arthritis follows a chronic indolent course of several months that may lead to delays in diagnosis and inappropriate treatments [1].…”

“…It has an estimated incidence of over 100,000 cases annually in the U.S. with most of these infections (one-half to two-thirds) manifesting subclinically or with only mild, isolated respiratory complaints [3-6]. Rare cases (1 ~ 5%) may cause extrapulmonary or disseminated disease [1,5,7,8]. Skin, lymph node, musculoskeletal, and central nervous system have been described as sites of dissemination [1,7,9].…”

“…Rare cases (1 ~ 5%) may cause extrapulmonary or disseminated disease [1,5,7,8]. Skin, lymph node, musculoskeletal, and central nervous system have been described as sites of dissemination [1,7,9]. We present two cases of coccidiomycosis mimicking a primary neoplasm of the patella in healthy, immunocompetent males.…”

Metagenomic next-generation sequencing assists the diagnosis treatment of fungal osteoarticular infections

“…Common routes of infection include direct inoculation, contiguous spread, and hematogenous dissemination ( Miller et al., 2015 ). FOI resulting from fungemia, skin lesion, or trauma was rarely reported ( Taxy and Kodros, 2005 ; Dewar and Sigler, 2010 ; Lee et al., 2012 ; Lu et al., 2012 ; Jeong et al., 2013 ; Cevik et al., 2016 ), while FOIs secondary to orthopedic surgeries were more commonly seen in literature, especially in implant-related cases. Implant-related fungal infections, typically fungal periprosthetic joint infection (PJI) after hip/knee arthroplasty, was even more difficult to diagnose and treat for the reason of biofilm formation on the bioprosthetic surfaces ( Cobo et al., 2016 ).…”