Coccidioides immitis Osteomyelitis of the Radius Presenting as Ewing's Sarcoma

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Coccidioides immitis osteomyelitis is a relatively rare manifestation of a disease that most commonly presents with pulmonary infection. Disseminated disease occurs in approximately 1% of infected individuals, with bony involvement in 10% to 50% of those patients with extrapulmonary infection. Diagnosis and treatment of patients with primarily osteoarticular complaints is frequently delayed, which may result in progression of disease and suboptimal results. This article discusses the successful treatment of a patient whose initial presentation was suggestive of Ewing's sarcoma of the proximal radius, but was found on biopsy to have coccidioidomycosis osteomyelitis. The patient was treated with surgical debridement and systemic as well as intralesional antifungal therapy. At 5-year follow-up, the patient has full motion, normal function, and symmetrical growth with complete skeletal remodeling.

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