The Spine Journal

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(2013)

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Disseminated coccidioidomycosis of the spine A 27-year-old man presented with neck pain. Computed tomography (CT) scan of the cervical spine showed nearcomplete destruction of the C5 vertebral body with focal kyphosis (Fig. 1). Magnetic resonance imaging showed a large retropharyngeal abscess with no evidence of epidural abscess or spinal cord compression (Fig. 2). Results of the CT-guided needle biopsy were positive for Coccidioides immitis. The patient underwent drainage of retropharyngeal abscess, C5 corpectomy, C4–6 arthrodesis with fibular allograft, and instrumentation. Two years after his initial surgery, he presented to the emergency room with a large, swollen wound on his left

Fig. 2. T2-weighted magnetic resonance imaging of the cervical spine showed a large retropharyngeal abscess with no evidence of epidural abscess or spinal cord compression.

flank (Fig. 3). Magnetic resonance imaging of the pelvis revealed that the wound communicated with a large granuloma mass extending deep into his pelvis (Fig. 4). A CT scan of the pelvis showed lytic lesions in the sacrum, ilium, and acetabulum (Fig. 5). Needle biopsy was obtained,

Fig. 1. Computed tomography scan sagittal reformat image shows nearcomplete destruction of the C5 vertebral body with focal kyphosis. 1529-9430/$ - see front matter Published by Elsevier Inc. http://dx.doi.org/10.1016/j.spinee.2013.10.003

Fig. 3. Photograph of the patient’s swollen left flank showing an overlying open wound.

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H. Elgafy et al. / The Spine Journal

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(2013)

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Fig. 5. Computed tomography scan of the pelvis showed lytic lesions in the sacrum and ilium. a

Fig. 4. T2-weighted coronal image of the pelvis showed a large granuloma mass extending deep into his pelvis and involving the psoas and iliacus muscles and communicating with the left flank wound.

which grew Coccidioides immitis and methicillin-sensitive Staphylococcus aureus. Hossein Elgafy, MD, FRCSEd, FRCSCa Jacob Miller, MDa Stephanie Meyers, BSb Ragheb Assaly, MDb

Department of Orthopedic Surgery University of Toledo Medical Center 3065 Arlington Ave., Toledo OH 43614, USA b Department of Medicine University of Toledo Medical Center 3000 Arlington Ave, Toledo OH 43614, USA FDA device/drug status: Approved (antifungal medication). Author disclosures: HE: Nothing to disclose. JM: Nothing to disclose. SM: Nothing to disclose. RA: Nothing to disclose.

Disseminated coccidioidomycosis of the spine.

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