Infect Chemother.  2009 Aug;41(4):253-257. 10.3947/ic.2009.41.4.253.

Recurrent Coccidioidomycosis Manifesting as Osteomyelitis in Korea

• Baek JH
• Park EY
• Jung YS
• Hong JW
• Chae Y
• Jin SJ
• Choi HK
• Shin SY
• Han SH
• Chin BS
• Kim CO
• Choi JY
• Song YG
• Cho NH
• Kim JM

• KMID: 1473678
• DOI: http://doi.org/10.3947/ic.2009.41.4.253

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.

Keyword

Coccidioidomycosis; Recurrence; Osteomyelitis; Complement fixation test

MeSH Terms

Coccidioides
Coccidioidomycosis
Complement Fixation Tests
Endemic Diseases
Humans
Immunocompromised Host
Incidence
Inhalation
Korea
North America
Osteomyelitis
Recurrence

Figure

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  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).

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  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)

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