Coccidioidomycosis is a
fungal infection endemic to the southwestern United States. Typically a respiratory illness,
coccidioidomycosis can rarely present as extrapulmonary
infection. Skeletal
coccidioidomycosis occurs in 20% to 50% of disseminated
infections. Skeletal
coccidioidomycosis is a chronic and progressive
infection that eventually results in bone destruction and loss of function and often involves adjacent structures, such as joints, muscles, and tendons and other soft tissues. Sinus tract formation may occur. This
infection may be multifocal. Although radiographs, white blood cell count scans, and other imaging methods identify and define relevant abnormalities, histopathologic examination with culture of the involved bone is the only means to confirm the diagnosis. Serologic testing is adjunctive, and
complement fixation titers can be evaluated serially to assess response to treatment. A number of studies addressing the efficacy of various
antifungal agents have been performed, and the results of these studies as they pertain to skeletal
coccidioidomycosis are summarized herein. Among the various studies, response rates ranged from 23% to 100%, but relapse was common. A combination of medical
therapy-often,
itraconazole or
fluconazole-and surgical débridement is often needed to control skeletal
coccidioidomycosis. Early diagnosis and treatment are critical to avoid long-term problems with chronically infected bones and joints. Anatomical issues, diagnostic studies, and data related to treatment of this form of extrapulmonary
coccidioidomycosis are reviewed in this article.