Majeed Aneela, Ullah Waqas, Hamadani Auon Abbas, Georgescu Anca
Infectious Disease Division, Department of Medicine, University of Arizona, Tucson, Arizona, USA.
Department of Medicine, University of Arizona, Tucson, Arizona, USA.
BMJ Case Rep. 2016 Nov 30;2016:bcr2016216804. doi: 10.1136/bcr-2016-216804.
Coccidioidomycosis is an insidious infection caused by Coccidioides spp (C. immitis and C. posadasii). Disseminated disease occasionally involves tendon sheaths and synovium of the joints leading to tenosynovitis. Here, we describe the case of a 72-year-old woman from southern Arizona, who presented with right ankle pain, redness and swelling for 2 months. Her serum IgG was positive for C. immitis on complement fixation, and her MRI of the right ankle joint showed extensive tenosynovitis of the right peroneal tendons, and subtalar joint effusions with associated synovitis. The purpose of this case is to report an extremely rare manifestation of disseminated C. immitis, that is, peroneal tenosynovitis and challenges involved with diagnosis and treatment. We also document that azole therapy is an effective treatment option for peroneal tenosynovitis caused by C. immitis, and we had to double the dose for slow symptom resolution with 4-week trial with usual 400 mg oral dose of fluconazole.
球孢子菌病是由球孢子菌属（粗球孢子菌和波萨达斯球孢子菌）引起的一种隐匿性感染。播散性疾病偶尔会累及腱鞘和关节滑膜，导致腱鞘炎。在此，我们描述了一名来自亚利桑那州南部的72岁女性病例，她出现右踝疼痛、红肿2个月。她的血清免疫球蛋白G在补体结合试验中对粗球孢子菌呈阳性，右踝关节磁共振成像显示右腓骨肌腱广泛腱鞘炎，距下关节积液并伴有滑膜炎。本病例的目的是报告播散性粗球孢子菌病一种极其罕见的表现，即腓骨腱鞘炎以及诊断和治疗中涉及的挑战。我们还记录到唑类疗法是治疗由粗球孢子菌引起的腓骨腱鞘炎的一种有效治疗选择，并且我们不得不将通常400毫克口服剂量的氟康唑进行为期4周的试验性加倍给药，以缓慢缓解症状。
