Coccidioidomycosis : Bone

Bone involvement in coccidioidomycosis is almost always secondary to spread from the lungs. The lesions are lytic, multiple and most commonly affect the axial skeleton (especially the spine), although any bone can be involved. Vertebral bodies, neural arches, and even contiguous ribs may be destroyed. The differential diagnosis is with tuberculous spondylitis. Coccidioidomycosis frequently involves joints as well, especially the knee joint and more distal small joints. Coccidioidal osteomyelitis is quite challenging to treat and may necessitate life-long suppressive antifungal therapy. The image shows a destructive, lytic lesion involving a cervical vertebra. The next four images are from the same case.