Although intravenous amphotericin B is generally considered to be the standard treatment for coccidioidomycosis, the treatment of monostotic coccidioidomycosis is controversial. Long-term intravenous and oral antifungal chemotherapy has been utilized alone and in conjunction with local surgical debridement. We present a case of coccidioidal osteomyelitis of a tarsal bone successfully treated with local surgical debridement and oral ketoconazole and propose clinical guidelines for selecting the proper chemotherapeutic agent and for following the efficacy of the treatment regimen
Get full access to this article
View all access options for this article.
References
1.
ConatyJ. P.BiddleM.McKeeverF. M.: Osseous coccidioidal granuloma. J. Bone Joint Surg., 41A: 1109–1122, 1959.
2.
DalinkaM. K.DinnenbergM. S.GreendykeW. H.HopkinsR.: Roentgenographic features of osseous coccidioidomycosis and differential diagnosis. J. Bone Joint Surg., 53A: 1157–1164, 1971.
3.
DefeliceR.GalgianeJ. N.CampbellS. C.PalpantS. D.FriedmanB. A.DodgeR. R.WeinbergM. G.LincolnL. D.TennicanP. C.BarbeeR. A.: Ketoconazole treatment of nonprimary coccidioidomycosis. Evaluation of 60 patients during three years of study. Am. J. Med., 72: 681–687, 1982.
4.
DeresinskiS. C.StevensD. A.: Bone and joint coccidioidomycosis treated with miconazole. Am. Rev. Respir. Dis., 120: 1101–1107, 1979.
5.
DrutzD. J.CatanzaroA.: Coccidioidomycosis. Part I. Am. Rev. Respir. Dis., 117: 559–585, 1978.
6.
DrutzD. J.CatanzaroA.: Coccidioidomycosis. Part II. Am. Rev. Respir. Dis., 117: 727–771, 1978.
7.
FieseM. J.: Pathology and pathogenesis of coccidioidomycosis. In Coccidioidomycosis. 1st Ed.Springfield, Ill., Charles C Thomas Co., 1958, pp. 104–128.
8.
HorsburghJ. R. C. R.CannadyJ. R. P. B.KirkpatrickC. H.: Treatment of fungal infections in the bones and joints with ketoconazole. J. Infect. Dis., 147: 1064–1069, 1983.
9.
IgerM.: Coccidioidal osteomyelitis. In Coccidioidomycosis in Current Clinical and Diagnostic Status. 3rd ed. AjelloL. (ed.), Miami, Symposia Specialists, 1977, pp. 177–190.
10.
JohnsonW. M.: Coccidioidomycosis mortality in Arizona. In Current Clinical and Diagnostic Status. 3rd ed. AjelloL. (ed.), Miami, Symposia Specialists, 1977, pp. 33–34.
11.
LeeJ. C.CatanzaroA.ParthermoreJ. G.RoachB.DeftosL. J.: Hypercalcemia in disseminated coccidioidomycosis. N. Engl. J. Med., 297: 431–433, 1977.
StadalnikR. C.GoldsteinE.HoeprichP. D.DossantosP. A. L.LeeK. K.: Diagnostic value of gallium and bone scans in evaluation of extrapulmonary coccidioidal lesions. Am. Rev. Respir. Dis., 121: 673–676, 1980.
14.
StevensD. A.StillerR. L.WilliamsP. L.SugarA. M.: Experience with ketoconazole in three major manifestations of progressive coccidioidomycosis. Am. J. Med., 74(1B):58–63, 1983.
15.
SzaboR. M.LanzerW. L.GelbermanR. H.HaghighiP.: Extensor tendon rupture due to Coccidioides immitis. Report of a case. Clin. Orthop., 194: 176–180, 1985.
