Coccidioidal Osteomyelitis of the Patella

Abstract

Known as "Valley Fever," coccidiomycosis is a soil-borne, fungal infection predominately found in endemic regions of the southwestern United States and Latin America. While most infected individuals are asymptomatic, <1% of patients have hematogenous seeding of bone, skin, and soft tissue. When the musculoskeletal system is involved, the knee is most commonly affected, although infection has been described in the spine, hand, wrist, ankle, foot, and pelvis. Treatment typically includes a combination of surgical debridement and antifungal treatment.An 11-year-old boy presented with a 7-month history of left anterior knee pain. Physical examination revealed mild knee effusion and quadriceps atrophy with focal tenderness to palpation to the distal pole of the patella. Laboratory studies were unremarkable and plain radiographs revealed a radiolucency in the inferomedial aspect of the patella. Magnetic resonance imaging revealed a corresponding focus of increased T2 signal with sclerotic margins and peripheral edema within the patella. Open biopsy with curettage confirmed coccidiomycosis, and the patient was successfully managed with long-term antifungal antibiotics.To our knowledge, this article presents the first known case of coccidioidal osteomyelitis of the patella.

Musculoskeletal Coccidioidomycosis in the Setting of Adalimumab: A Case Report

“…Definitive diagnosis can be established with a biopsy of the skeletal or soft tissue lesion. Histologic examination of the above-mentioned biopsy sample will demonstrate characteristic spherules that contain hundreds of endospores [ 4 , 6 , 7 ]. These endospores can initiate a neutrophilic inflammatory reaction followed by a non-caseating granulomatous response with giant cells that closely resemble tuberculosis [ 6 ].…”

“…Coccidioidomycosis, also known as San Joaquin Valley Fever, is a fungal infection that results from inhalation of aerosolized spores produced by either Coccidioides immitis or Coccidioides posadasii [1][2][3][4][5][6][7][8][9][10]. These dimorphic fungi are endemic in the southwestern United States and northwestern Mexico, as well as Guatemala, Brazil, and other locations in Central and South America where they typically reside in the soil [1][2][3][4][5][6][7][8][9][10]. The primary infection typically presents as community-acquired pneumonia with influenza-like symptoms, but less than 40% of patients become symptomatic [2,3,6,7,9,11].…”

“…Common risk factors for developing symptomatic coccidioidomycosis are male gender, pregnancy, immunosuppression, and African or Pacific Islander ancestry [1,2,5,6,9,10]. Dissemination of coccidioidomycosis is exceedingly rare and occurs in less than 1% of patients by way of hematogenous or lymphatic spread [1][2][3][4]6]. The most common extrapulmonary sites of dissemination include the skin, lymph nodes, musculoskeletal system, and meninges [1][2][3][4]6,8].…”

“…Dissemination of coccidioidomycosis is exceedingly rare and occurs in less than 1% of patients by way of hematogenous or lymphatic spread [1][2][3][4]6]. The most common extrapulmonary sites of dissemination include the skin, lymph nodes, musculoskeletal system, and meninges [1][2][3][4]6,8]. Approximately 20-50% of disseminated infections involve the musculoskeletal system [1][2][3][4]6,8].…”

“…The most common extrapulmonary sites of dissemination include the skin, lymph nodes, musculoskeletal system, and meninges [1][2][3][4]6,8]. Approximately 20-50% of disseminated infections involve the musculoskeletal system [1][2][3][4]6,8].…”