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Disseminated Coccidioidomycosis

Olson MO - MedPix (2009)

View Article: MedPix Image - MedPix Case

Affiliation: Naval Medical Center San Diego

ABSTRACT

Diagnosis: Disseminated Coccidioidomycosis

History: The patient is a 23 year old man who presented with four weeks of persistent mid back pain. He received pain medications with minimal relief. His pain gradually worsened over three months to involve his left leg and hip. The patient had associated fevers, weight loss, night sweats, fatigue, and intermittent abdominal pain.

Findings: The frontal and lateral views of the thoracic spine demonstrate a mixed lucent/sclerotic appearance of the T12 vertebral body and the left pedicle. A sagittal view MRI with gadolinium of the thoracic spine and lumbar spine demonstrates enhancing lesions multiple vertebrae, including T12. Soft tissue enhancement is also present from T9-L2 paraspinal muscles. A sagittal nonconstrast CT obtained several weeks later demonstrates worsening expansile lytic lesions to T10, T11, and T12. MRI of the thoracic spine was obtained five months after the patient began treatment. Interval worsening present at multiple levels, including multiple compression deformities and enhancing mass with cortical disruption and contiguous anterior soft tissue mass lifting the anterior longitudinal ligament. Involvment of the posterior elements is present with narrowing of multiple neural foramina and spinal cord compression.

Ddx: --Osteomyelitis, including mycobacterial and fungal. --Metastatic disease --Multiple myeloma

Dxhow: A biopsy of the L3 vertebral body lesion demonstrates Coccidioides spores.

Exam: Pertinent physical exam findings included: » splenomegaly to 1 cm below the costal margin » mild tenderness to palpation in the left upper quadrant » 1-2 cm firm immobile nodule left midclavicular costovertebral margin » midline tenderness to T12 and L1 » decreased range of motion in flexion secondary to pain. WBC: 9.39 Hgb:11.2 Hct:35.7 Plt:535 ESR:117

No MeSH data available.


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Disseminated Coccidioidomycosis

Olson MO - MedPix (2009)

© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1043&req=5

View Article: MedPix Image - MedPix Case

Affiliation: Naval Medical Center San Diego

ABSTRACT

Diagnosis: Disseminated Coccidioidomycosis

History: The patient is a 23 year old man who presented with four weeks of persistent mid back pain. He received pain medications with minimal relief. His pain gradually worsened over three months to involve his left leg and hip. The patient had associated fevers, weight loss, night sweats, fatigue, and intermittent abdominal pain.

Findings: The frontal and lateral views of the thoracic spine demonstrate a mixed lucent/sclerotic appearance of the T12 vertebral body and the left pedicle. A sagittal view MRI with gadolinium of the thoracic spine and lumbar spine demonstrates enhancing lesions multiple vertebrae, including T12. Soft tissue enhancement is also present from T9-L2 paraspinal muscles. A sagittal nonconstrast CT obtained several weeks later demonstrates worsening expansile lytic lesions to T10, T11, and T12. MRI of the thoracic spine was obtained five months after the patient began treatment. Interval worsening present at multiple levels, including multiple compression deformities and enhancing mass with cortical disruption and contiguous anterior soft tissue mass lifting the anterior longitudinal ligament. Involvment of the posterior elements is present with narrowing of multiple neural foramina and spinal cord compression.

Ddx: --Osteomyelitis, including mycobacterial and fungal. --Metastatic disease --Multiple myeloma

Dxhow: A biopsy of the L3 vertebral body lesion demonstrates Coccidioides spores.

Exam: Pertinent physical exam findings included: » splenomegaly to 1 cm below the costal margin » mild tenderness to palpation in the left upper quadrant » 1-2 cm firm immobile nodule left midclavicular costovertebral margin » midline tenderness to T12 and L1 » decreased range of motion in flexion secondary to pain. WBC: 9.39 Hgb:11.2 Hct:35.7 Plt:535 ESR:117

No MeSH data available.