Overview
Coccidioidomycosis of bone, also known as coccidioidal osteomyelitis, is a chronic infection caused by the dimorphic fungus Coccidioides species, typically affecting bone following primary pulmonary infection or disseminated disease 1.Diagnosis
Clinical Presentation: Dyspnea, hypoxemia, and neurological deficits may indicate complications such as pulmonary arteriovenous fistulas 1.
Imaging: CT, MRI, and pulmonary angiography are crucial for identifying structural abnormalities like fistulas 1.
Laboratory Tests: Serology (e.g., coccidioidal immunodiffusion test) and culture of bone or other tissues can confirm the diagnosis 1.Management
Surgical Intervention: Resection of pulmonary arteriovenous fistulas may be necessary for severe complications to improve oxygenation 1.
Antifungal Therapy: Specific drug classes and doses are not detailed in the provided abstracts; however, standard treatments include fluconazole, itraconazole, or amphotericin B, tailored to the severity and extent of disease 1.
Supportive Care: Oxygen therapy and management of complications such as cerebral infarctions are essential 1.Special Populations
Postoperative Complications: Patients undergoing pulmonary wedge resection for coccidioidomycosis may be at risk for unusual complications like pulmonary arteriovenous fistulas 1.Key Recommendations
Evaluate for Pulmonary Complications: Postoperatively monitor for unusual complications such as pulmonary arteriovenous fistulas in patients with a history of coccidioidomycosis surgery (Evidence: Expert opinion) 1.
Imaging for Structural Abnormalities: Utilize advanced imaging techniques including MRI and pulmonary angiography to diagnose complications like fistulas (Evidence: Moderate) 1.
Surgical Resection for Severe Cases: Consider surgical resection of identified pulmonary arteriovenous fistulas to improve oxygenation and reduce dependency on supplemental oxygen (Evidence: Weak) 1.References
1 Leduc F, Thipphavong S, Matzinger F, Dennie C, Sundaresan S. Unusual presentation of a complication after pulmonary wedge resection for coccidioma. The Annals of thoracic surgery 2009. link