Published in:
01-06-2020 | Vertebra Plana | Clinical Image
Coccidioidomycosis Presenting with Fever and Back Pain
Published in: Journal of General Internal Medicine | Issue 6/2020
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A 31-year-old man presented with 8 months of progressive upper back pain and 2 weeks of fever and leg weakness. He was born in Mexico and later moved to Salinas, CA, where he worked in agriculture. He denied injection drug use. Neurologic exam showed 4/5 left leg strength, hyperreflexia, and upward Babinski. There were no sensory changes. Magnetic resonance imaging showed C7–T4 osteomyelitis/discitis, T3 vertebra plana (complete vertebral body compression), and epidural fluid collection with cord compression (Fig. 1). He underwent spinal decompression with instrumentation. Pathology showed granulomatous inflammation with spherules (Fig. 2) and cultures grew Coccidioides immitis.]-->
Figure 1
T2-weighted magnetic resonance imaging of the spine with contrast (sagittal view) showing C7-T4 osteomyelitis/discitis (labeled) and T3 vertebra plana (solid arrow) with associated epidural fluid collection (open arrow) and cord compression.
Figure 2
H&E stain (× 400 magnification) of epidural soft tissue showing granulomatous inflammation withCoccidioidesspherules (solid arrow) containing endospores and adjacent giant cell (open arrow).
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