Journal List > Infect Chemother > v.41(4) > 1075474

Baek, Park, Jung, Hong, Chae, Jin, Choi, Shin, Han, Chin, Kim, Choi, Song, Cho, and Kim: Recurrent Coccidioidomycosis Manifesting as Osteomyelitis in Korea

Abstract

Coccidioidomycosis is a fungal infection that results from inhaling the airborne arthroconidia of the Coccidioides species. It is an endemic disease in the southwest part of North America and rarely diagnosed in Korea. As tourism to endemic areas and the number of immunocompromised patients have been increasing, the incidence of this infection has increased in non-endemic areas. Treatment is usually successful with antifungal agents; however, recurrence is common. It is difficult to decide when to discontinue the antifungal treatment especially in non-endemic areas where doctors are not familiar with the disease. We report a case of recurrent coccidioidomycosis manifesting as osteomyelitis after the treatment of the patient for disseminated coccidioidal infection. The complement fixation test was a useful tool for the assessment of patient response and to evaluate suspected recurrence.

Figures and Tables

Figure 1
MRI of midfoot, T2 weighted image shows thick and heterogeneous hyperintensity on the navicular and cuneiform bone with a multilocular effusion with thick rim on the dorsal and plantar area of the midfoot (arrows).
ic-41-253-g001
Figure 2
(A) Hematoxylin and Eosin staining revealed chronic granulomatous inflammation with caseous necrosis. (Left cuneiform, ×100). (B) Endosporulating spherules of Coccidioides immitis were confirmed by periodic acid-Schiff staining.(Left cuneiform, ×400)
ic-41-253-g002

References

1. Galgiani JN. Coccidioidomycosis: a regional disease of national importance. rethinking approaches for control. Ann Intern Med. 1999. 130:293–300.
crossref
2. Spinello IM, Munoz A, Johnson RH. Pulmonary coccidioidomycosis. Semin Respir Crit Care Med. 2008. 29:166–173.
crossref
3. Anstead GM, Graybill JR. Coccidioidomycosis. Infect Dis Clin North Am. 2006. 20:621–643.
crossref
4. Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Johnson RH, Stevens DA, Williams PL. Infectious Diseases Society of America. Coccidioidomycosis. Clin Infect Dis. 2005. 41:1217–1223.
crossref
5. Kim JH, Hur GY, Jung KH, Jung HC, Park DW, Lee SY, Lee SY, Kim JH, Shon JU, Shin C, Shim JJ, In KH, Kang KH, Yoo SH. Disseminated coccidioidomycosis presenting with miliary nodules. Tuberc Respir Dis. 2006. 60:97–101.
crossref
6. Park JC, Kim JH, Ku NS, Lee KH, Choi YK, Lee YH, Kim YK, Kim MS, Song YG, Shin SY, Kim YA, Park YS, Cho SH, Kim CK, Yong D, Choi JY, Kim JM. A case of disseminated coccidioidomycosis with pelvic bone and paravertebral abscess. Infect Chemother. 2006. 38:296–299.
7. Sinn DH, Kwon YS, Choi SY, Chang WI, Park MK, Han J, Chung MP. A case of pulmonary coccidioidomycosis mimicking lung cancer. Korean J Med. 2005. 69:419–423.
8. Kim JH, Kim MA, Yang SK, Choi TY, Kim CW, Kim KH. A Case of coccidioidomycosis. Korean J Dermatol. 1976. 14:73–79.
9. Drutz DJ, Catanzaro A. Coccidioidomycosis. Part I. Am Rev Respir Dis. 1978. 117:559–585.
10. Saubolle MA. Laboratory aspects in the diagnosis of coccidioidomycosis. Ann N Y Acad Sci. 2007. 1111:301–314.
crossref
11. Johnson RH, Einstein HE. Amphotericin B and coccidioidomycosis. Ann N Y Acad Sci. 2007. 1111:434–441.
crossref
12. Sandoval JJ, Shank JR, Morgan SJ, Agudelo JF, Price CS. Midfoot coccidioidal osteomyelitis. A case report and review of the literature. J Bone Joint Surg Am. 2006. 88:861–865.
crossref
13. Catanzaro A, Galgiani JN, Levine BE, Sharkey-Mathis PK, Fierer J, Stevens DA, Chapman SW, Cloud G. NIAID Mycoses Study Group. Fluconazole in the treatment of chronic pulmonary and nonmeningeal disseminated coccidioidomycosis. Am J Med. 1995. 98:249–256.
crossref
14. Diaz M, Puente R, de Hoyos LA, Cruz S. Itraconazole in the treatment of coccidioidomycosis. Chest. 1991. 100:682–684.
crossref
15. Parish JM, Blair JE. Coccidioidomycosis. Mayo Clin Proc. 2008. 83:343–349.
crossref
16. Yeo SF, Wong B. Current status of nonculture methods for diagnosis of invasive fungal infections. Clin Microbiol Rev. 2002. 15:465–484.
crossref
17. Pappagianis D, Zimmer BL. Serology of coccidioidomycosis. Clin Microbial Rev. 1990. 3:247–268.
crossref
18. Oldfield EC 3rd, Bone WD, Martin CR, Gray GC, Olson P, Schillaci RF. Prediction of relapse after treatment of coccidioidomycosis. Clin Infect Dis. 1997. 25:1205–1210.
crossref
19. Bissell SR, Weiss EC. Centers for Disease Control and Prevention (CDC). Increase in coccidioidomycosis - California, 2000-2007. MMWR Morb Mortal Wkly Rep. 2009. 58:105–109.
20. Centers for Disease Control and Prevention (CDC). Increase in coccidioidomycosis--Arizona, 1998- 2001. MMWR Morb Mortal Wkly Rep. 2003. 52:109–112.
TOOLS
Similar articles