Disseminated Coccidioidomycosis of the Spine in an Immunocompetent Patient

Am J Orthop (Belle Mead NJ). 2014 Aug;43(8):E181-4. Hossein Elgafy, Jacob Miller, Stephanie Meyers, Ragheb Assaly

Abstract Coccidioidomycosis infections result from inhalation of the dimorphic fungus Coccidiodes immitis. Coccidioidomycosis typically is benign, but its extremely rare disseminated form can result in significant morbidity and mortality. Dissemination of the fungus to the spine is difficult to control and usually requires an aggressive combination approach (surgical/medical). In this article, we report the case of a 27-year-old Indonesian man with vertebral osteomyelitis caused by disseminated coccidioidomycosis. We outline the case management (includes 30-month follow-up) and review the treatment recommendations. The patient presented with an unstable C5 pathologic fracture caused by C immitis. After corpectomy and stabilization of the cervical spine along with antifungal therapy with amphotericin B and oral fluconazole, he developed multiple complications. This case illustrates some of the potential pitfalls in managing spinal osteomyelitis caused by C immitis and the need for continuous medical therapy after surgical treatment.