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Coccidioidal Spondylitis: Report of a Case with Unusual Spinal Imaging Features 2005

General Spine

Carmen L. Anderson, MD
Gregg H Zoarski , MD, ASSR Member

Excerpta

Coccidioidomycosis is a fungal infection with has regional predilection, affecting those in the southwestern United States, Central America, and South America. In all cases of coccidioidomycosis, dissemination occurs in 0.5%. Disseminated coccidioidomycosis with central nervous system manifestations is even more uncommon. Involvement of the spine is exceedingly rare, occurring in only 25% of those with disseminated disease. "Typical" radiological findings of coccidioidal spondylitis have been reported to include preservation of the intervertebral disk spaces, involvement of the vertebral bodies, and paraspinal soft tissue masses without gibbous deformity of the spine. We report a case of coccidioidal spondylitis with emphasis on its unusual imaging presentation in the spine. Plain radiographs and MR imaging in this patient demonstrated an unusual radiographic presentation of vertebral osteomyelitis with loss of the intervertebral disk spaces, prevertebral and paravertebral abscesses with epidural extension, and seeding of the spinal cord is illustrated.