Disseminated Skeletal Coccidioidomycosis: A Case Report and Comprehensive Review

Coccidioidomycosis, caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii, is endemic to arid regions such as the southwestern United States. Infection typically occurs via inhalation of aerosolized arthroconidia from disrupted soil. In the majority of cases, infection is asymptomatic or results in self-limiting respiratory symptoms; however, dissemination beyond the lungs may occur rarely. Disseminated disease is a rare occurrence, most commonly affecting the skeletal and central nervous systems, with skeletal involvement often manifesting as osteomyelitis in axial locations. This case presents a previously healthy 27-year-old male from an endemic region who developed severe disseminated skeletal coccidioidomycosis without preceding respiratory symptoms. Despite multiple antibiotic treatments prior to admission, his condition progressed to widespread lytic bone lesions and soft tissue abscesses. Neoplastic, rheumatologic, and immunodeficiency-related etiologies were systematically ruled out, and a bone biopsy in conjunction with positive serological findings confirmed Coccidioides fungemia. The patient's risk factors included male sex, Pacific Islander ethnicity, and geographic exposure, all of which are associated with increased susceptibility. Imaging modalities such as CT and MRI play a critical role in identifying characteristic lytic bone lesions, soft tissue abscesses, and joint space involvement. This case highlights the severity of disseminated coccidioidomycosis presentations and barriers to timely diagnosis in such cases, particularly in the absence of preceding respiratory symptoms. The patient's favorable response to initial amphotericin B followed by oral azole therapy underscores the importance of early, aggressive antifungal treatment. Beyond this clinical presentation, the report provides a comprehensive review of the disease's risk factors, diagnostic challenges, and current management strategies. Recognition of this infection's potential severity, along with a nuanced understanding of its clinical and epidemiologic features, is essential for improving outcomes in affected populations.