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Coccidioidal osteomyelitis of the patella
Brian R Waterman1, Scott M Waterman, Andrew C McCoy
1Orthopaedic Surgery and Rehabilitation Service, William Beaumont Army Medical Center, 5005 N Piedras St, El Paso, TX 79920-5001, USA. Brian.waterman@amedd.army.mil
Orthopedics
|April 27, 2010
Summary
Coccidioidomycosis, or Valley Fever, can cause bone infections. This case study details the first known instance of coccidioidal osteomyelitis affecting the patella in an 11-year-old boy.
Area of Science:
- Mycology
- Infectious Diseases
- Orthopedic Surgery
Background:
- Coccidioidomycosis (Valley Fever) is a fungal infection endemic to the southwestern US and Latin America.
- While often asymptomatic, it can disseminate hematogenously, affecting bone, skin, and soft tissues.
- Musculoskeletal involvement, particularly of the knee, is a known complication, though rare.
Observation:
- An 11-year-old boy presented with chronic left anterior knee pain, effusion, and quadriceps atrophy.
- Radiographs showed a patellar radiolucency; MRI revealed increased T2 signal, sclerosis, and edema.
- Open biopsy confirmed coccidioidomycosis.
Findings:
- The patient was diagnosed with coccidioidal osteomyelitis of the patella.
- This represents the first documented case of patellar involvement in coccidioidomycosis.
- Successful management was achieved with surgical debridement and long-term antifungal therapy.
Implications:
- Highlights the potential for coccidioidomycosis to manifest as osteomyelitis in unusual skeletal locations.
- Emphasizes the importance of considering fungal infections in the differential diagnosis of pediatric bone lesions in endemic areas.
- Underscores the efficacy of combined surgical and antifungal treatment for this rare presentation.
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