Surgical pathology of skeletal coccidioidomycosis

A Clinical and histopathologic analysis of 25 cases

Robert W. Ricciotti, Tatyana A. Shekhel, Janis E. Blair, Thomas V. Colby, Richard E. Sobonya, Brandon Larsen

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Skeletal coccidioidomycosis is a rare complication of pulmonary coccidioidomycosis that remains incompletely characterized, and its histopathologic features have not been systematically evaluated. All skeletal coccidioidal infections (2000 to 2012) were retrieved from the University of Arizona and Mayo Clinic in Arizona pathology archives. Clinical history and histologic features were reviewed. Among 25 patients (median age 40 y; 17 men), infections involved bones (2 cases), joints (6), or both (17), usually in the distal extremities (68%), especially the wrist (32%). History included previously documented coccidioidomycosis (13), autoimmune disease (8), diabetes (6), malignancy (4), and iatrogenic immunosuppression (10). Common symptoms (median 3 mo) included pain/arthralgia (21) and swelling (10). Cultures and serology were positive in 15 of 17 (88%) and 19 of 22 patients (86%), respectively. Treatment included surgical debridement(s) and chronic antifungal medication(s). Histologic review showed granulomas in all cases, ranging from poorly to well formed, with or without necrosis. Spherule density varied widely (mean 4.8/HPF; range <0.1 to 13.5/HPF). Composition of inflammatory infiltrates, degree of necrosis, and extent of fibrosis did not significantly differ between immunocompetent and immunocompromised patients. Eosinophils were only seen in one third of cases; when present, eosinophils were almost always rare. 10 patients experienced recurrent infection, 8 of whom were immunocompromised; the remaining patients recovered. In conclusion, distal extremities are the most common sites of skeletal coccidioidomycosis encountered by surgical pathologists. This condition is strongly associated with autoimmune disorders and immunosuppression. Spherules are sometimes rare, and multiple modalities including serology, culture, and histology may be required for diagnosis.

Original languageEnglish (US)
Pages (from-to)1672-1680
Number of pages9
JournalAmerican Journal of Surgical Pathology
Volume38
Issue number12
StatePublished - 2014

Fingerprint

Coccidioidomycosis
Surgical Pathology
Serology
Eosinophils
Immunosuppression
Necrosis
Extremities
Infection
Arthralgia
Immunocompromised Host
Debridement
Granuloma
Wrist
Autoimmune Diseases
Histology
Fibrosis
Joints
History
Pathology
Bone and Bones

Keywords

  • Coccidioides
  • Coccidioidomycosis
  • Fungal osteomyelitis
  • Fungal synovitis
  • Skeletal infection

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery
  • Medicine(all)

Cite this

Ricciotti, R. W., Shekhel, T. A., Blair, J. E., Colby, T. V., Sobonya, R. E., & Larsen, B. (2014). Surgical pathology of skeletal coccidioidomycosis: A Clinical and histopathologic analysis of 25 cases. American Journal of Surgical Pathology, 38(12), 1672-1680.

Surgical pathology of skeletal coccidioidomycosis : A Clinical and histopathologic analysis of 25 cases. / Ricciotti, Robert W.; Shekhel, Tatyana A.; Blair, Janis E.; Colby, Thomas V.; Sobonya, Richard E.; Larsen, Brandon.

In: American Journal of Surgical Pathology, Vol. 38, No. 12, 2014, p. 1672-1680.

Research output: Contribution to journalArticle

Ricciotti, RW, Shekhel, TA, Blair, JE, Colby, TV, Sobonya, RE & Larsen, B 2014, 'Surgical pathology of skeletal coccidioidomycosis: A Clinical and histopathologic analysis of 25 cases', American Journal of Surgical Pathology, vol. 38, no. 12, pp. 1672-1680.
Ricciotti, Robert W. ; Shekhel, Tatyana A. ; Blair, Janis E. ; Colby, Thomas V. ; Sobonya, Richard E. ; Larsen, Brandon. / Surgical pathology of skeletal coccidioidomycosis : A Clinical and histopathologic analysis of 25 cases. In: American Journal of Surgical Pathology. 2014 ; Vol. 38, No. 12. pp. 1672-1680.
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