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Midfoot Coccidioidal OsteomyelitisA Case Report and Review of the Literature
John J. Sandoval, MD1; John R. Shank, MD1; Steven J. Morgan, MD1; Juan F. Agudelo, MD1; Connie S. Price, MD1
1 Departments of Orthopaedics (J.J.S., J.R.S., S.J.M., and J.F.A.) and Medicine, Division of Infectious Diseases (C.S.P.), Denver Health Medical Center and School of Medicine, University of Colorado Health Sciences Center, 777 Bannock Street, Denver, CO 80204. E-mail address for J.F. Agudelo: juan.agudelorivera@uchsc.edu
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The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Departments of Orthopaedics and Medicine, Division of Infectious Diseases, Denver Health Medical Center and School of Medicine, University of Colorado School of Medicine, Denver, Colorado

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Apr 01;88(4):861-865. doi: 10.2106/JBJS.E.00176
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Coccidioides immitis is endemic in arid parts of the southwestern United States and regions of Central and South America. Symptomatic infection (comprising 40% of cases) initially presents as a flu-like illness with fever, cough, headache, rash, and myalgias. Some patients (especially those who are immunocompromised) fail to recover, with the development of chronic pulmonary infection or widespread disseminated infection1.A Coccidioides immitis infection that is disseminated to bone is very difficult to treat and usually requires lifetime suppressive antifungal therapy1-3. The present report describes a patient with recurrent osseous coccidioidal osteomyelitis at a new locus who presented after minor trauma to the middle part of the foot. The patient was managed successfully with surgical débridement and antifungal medication. The pathophysiology of osseous infection and treatment options are discussed. The patient was informed that data concerning this case would be submitted for publication.
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