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Disseminated coccidioidomycosis
  1. Teresa Fox1,
  2. Robin Solomon2,
  3. Anjum Kaka1
  1. 1Department of Infectious Diseases, Minneapolis VA Health Care System, University of Minnesota, Minneapolis, Minnesota, USA
  2. 2Department of Pathology, Minneapolis VA Health Care System, University of Minnesota, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Teresa Fox, Department of Infectious Diseases, Minneapolis VA Health Care System, University of Minnesota, Minneapolis, MN 55417-2309, USA; foxx0243{at}umn.edu

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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 …

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