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Skeletal coccidioidomycosis: an atypical pediatric presentation
Lane H McCoy1, John S A Chrisinger2,3, Benjamin E Northrup2,4
1Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO, USA. l.h.mccoy@wustl.edu.
Skeletal Radiology
|July 28, 2026
Summary
Skeletal coccidioidomycosis is a rare manifestation of a fungal infection, particularly in children. This case highlights key imaging findings for early diagnosis of pelvic involvement, enabling prompt treatment and full recovery.
Area of Science:
- Mycology
- Pediatric Orthopedics
- Infectious Diseases
Background:
- Coccidioidomycosis typically presents as a pulmonary infection, with disseminated disease, especially skeletal involvement, being rare.
- Skeletal coccidioidomycosis is an uncommon manifestation in pediatric patients, often presenting without typical pulmonary symptoms.
Purpose of the Study:
- To report a case of skeletal coccidioidomycosis in a 12-year-old presenting with pelvic pain.
- To emphasize the importance of considering coccidioidomycosis in the differential diagnosis of aggressive pediatric osseous lesions.
Main Methods:
- A case report of a 12-year-old patient with atraumatic pelvic pain, night sweats, and weight loss.
- Radiographic and MRI imaging were utilized to characterize the osseous lesion.
- Histopathological examination and fungal culture confirmed Coccidioides infection.
- Treatment involved intravenous amphotericin B followed by oral itraconazole.
Main Results:
- Imaging revealed a lytic lesion of the left ilium with ill-defined margins, reactive sclerosis, and a soft-tissue component with diffusion restriction suggestive of abscess.
- Histopathology confirmed fungal elements consistent with Coccidioides.
- The patient responded well to antifungal therapy, with complete resolution of pain and preserved pelvic function at 6-month follow-up.
Conclusions:
- Skeletal coccidioidomycosis should be included in the differential diagnosis of pediatric osseous lesions, even without pulmonary symptoms.
- Characteristic imaging findings can aid in early diagnosis and prevent misdiagnosis.
- Timely diagnosis and treatment lead to favorable outcomes and reduced morbidity.
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