June 22, 2015
A 33-year-old man from Arizona with complaints of worsening back pain, shortness of breath, and cough with hemoptysis
Coccidiodomycosis Spondylitis
- Background: Fungal disease caused by Coccidioides immitis, spores of which reside in soil of endemic areas (San Joaquin Valley of California, and parts of Arizona, Utah, New Mexico, Nevada, Texas, and Northern Mexico).
- Clinical Information: More common in men, African Americans, Hispanics, and those with high dust exposure. Patients initially may be asymptomatic and progressively develop flu-like symptoms, followed by fever, rash, arthralgias, and pulmonary symptoms. Disseminated disease occurs in < 1%; immunocompromised individuals are at increased risk of severe disease.
- Key Diagnostic Features:
- Solitary/multifocal areas of lung consolidation and/or cavitary nodules, hilar lymphadenopathy, pleural effusions (20%).
- Bone involvement/osteomyelitis manifests as aggressive erosive changes with disc space sparing.
- Soft tissue masses are rare.
- DDx:
- Tuberculous spondylitis
- Other atypical spondylodiscitis (fungal agents, brucellosis)
- Malignancy
- Treatment: Azole antifungals, Amphotericin B. Refractory cases of vertebral osteomyelitis may require surgical debridement and stabilization.
