Spinal Coccidioidomycosis: MR Imaging Findings in 41 Patients

Coccidioides immitis is a dimorphic fungus endemic to the Southwest United States and Mexico, and at our institution, it is a relatively common pathogen presenting with a broad spectrum of associated spine diseases. We describe the various spinal manifestations resulting from coccidioidal infection and provide MR imaging examples from 41 pathologically proved cases.

Retrospective electronic medical record and PACS searches were performed. Patients found to have both MR imaging findings positive for infection and confirmative biopsy and/or CSF studies were included. Abnormal MR imaging findings were identified, categorized, and quantified. Patient demographics and associated intracranial involvement if present were also recorded.

Forty-one patients were included. Positive findings were categorized as leptomeningeal enhancement (26 patients, 63%), arachnoiditis (22 patients, 54%), osteomyelitis-discitis (14 patients, 34%), cord edema (11 patients, 27%), and true syrinx (3 patients, 7%). Thirty patients had documented brain involvement (73%), most commonly in the form of basilar meningitis. Four patients were positive for HIV (10%). Fifteen patients had pulmonary manifestations at presentation (37%).

C immitis results in various spinal manifestations, most commonly leptomeningeal enhancement and arachnoiditis/adhesive disease followed by osteomyelitis, which may resemble tuberculous or pyogenic infection on MR imaging.