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A 79-year-old man with type 2 diabetes and neuropathy presented to a Minneapolis hospital with 3 months of headaches and right ankle redness, swelling and pain. MRI of the ankle showed bony erosions (figure 1). Ankle synovial fluid had 30 000 white blood cells/mm3 (93% neutrophils); synovial fluid culture was positive for Coccidioides spp., confirmed by DNA probe. Serum complement-fixing anti-Coccidioides antibodies were positive at a titre of 1:128. Brain MRI was unremarkable. Cerebrospinal fluid (CSF) analysis revealed pleocytosis and an elevated CSF protein supporting a diagnosis of meningitis; CSF Coccidioides antigen, anti-Coccidioides antibody testing and fungal cultures were negative. Additional history revealed that the …
Contributors TF and AK contributed to the planning for the submission. TF and AK contributed to the initial drafting of the article. RS assisted with acquiring and interpreting the pathological findings. TF, AK and RS contributed to the background research required to prepare the article. TF, AK and RS participated in editing and revision of the article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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