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Relapse of Pediatric Coccidioidomycosis Tenosynovitis

Jefferson Li1, Cynthia R Fata2, Fred Laningham3

  • 1Department of Orthopaedic Surgery, University of California, San Francisco: Fresno, Fresno, CA.

Journal of Hand Surgery Global Online
|June 16, 2023
PubMed

Insights

Disseminated coccidioidomycosis is a rare cause of pediatric flexor tendon tenosynovitis. This case highlights a relapse in an infant, emphasizing the need for considering coccidioidomycosis in endemic areas with hand infections.

Area of Science:

  • Infectious Diseases
  • Pediatric Rheumatology
  • Surgical Pathology

Background:

  • Disseminated coccidioidomycosis is uncommon in children.
  • Flexor tendon tenosynovitis is a rare manifestation of this fungal infection.
  • Pediatric cases require careful diagnostic consideration, especially in endemic regions.

Observation:

  • A 2-month-old infant presented with disseminated coccidioidomycosis affecting the right index finger.
  • Initial treatment involved debridement and antifungal therapy.
  • Relapse occurred six months after discontinuing antifungal medication.

Findings:

  • Serial debridement and prolonged antifungal treatment led to disease quiescence.
  • The case illustrates relapse of pediatric coccidioidomycosis tenosynovitis.
  • Diagnostic tools included MRI, histopathology, and intraoperative findings.

Implications:

  • Coccidioidomycosis should be included in the differential diagnosis for pediatric hand infections in endemic areas.
  • This case underscores the importance of long-term monitoring for relapse.
  • Effective management involves a combination of surgical intervention and sustained antifungal therapy.

Keywords:
Atypical hand infectionsCoccidioidomycosisPediatric hand surgery

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