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Key Features

  • Candidal osteomyelitis

    • Occurs in malnourished patients undergoing prolonged hospitalization for cancer, neutropenia, trauma, complicated abdominal surgical procedures, or injection drug use

    • Infected intravenous catheters frequently serve as a hematogenous source

  • Coccidioidomycosis

    • Usually secondary to a primary pulmonary infection

    • Arthralgia with periarticular swelling, especially in the knees and ankles, occurring as a nonspecific manifestation of systemic coccidioidomycosis, should be distinguished from actual bone or joint infection

    • Osseous lesions commonly occur in cancellous bone of the vertebrae or near the ends of long bones at tendinous insertions; these lesions are initially osteolytic and thus may mimic metastatic tumor or myeloma

Clinical Findings

  • Joint and bone pain and swelling

Diagnosis

  • Culture studies of synovial fluid

  • Coccidioidomycosis

    • Recovery of Coccidioides immitis from the lesion or histologic examination of tissue obtained by open biopsy

    • Rising titers of complement-fixing antibodies also provide evidence of the disseminated nature of the disease

Treatment

  • Candidal: fluconazole, 200 mg twice daily orally, is probably as effective as amphotericin

  • Coccidioidomycosis

    • Fluconazole or ketoconazole, 400 mg daily orally

    • Itraconazole, 200 mg twice daily orally for 6–12 mo

    • May require operative excision of infected bone and soft tissue

    • Amputation may be the only solution for stubbornly progressive infections

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