The clinical course of disseminated coccidioidomycosis is highly
variable. Neither spontaneous cure nor spontaneous ankylosis has ever been
demonstrated in an adult with the disease in one or more disseminated
articular foci. Coccidioidomycotic arthritis may fluctuate in activity, and
may be compatible with years of limited function and moderate morbidity.
Amputation as well as arthrodesis accompanied by adequate excision of
diseased tissue are generally reliable methods of treatment of infected
joints, but the decision whether or not to "cover" such patients with
systemic doses of amphotericin is still difficult, and the roles of
synovectomy and topical amphotericin remain to be determined.