Skeletal coccidioidomycosis: an atypical pediatric presentation.
Lane H McCoy, John S A Chrisinger, Benjamin E Northrup et al.
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Case in brief
A previously healthy 12-year-old presented with 1.5 months of progressive left pelvic pain, night sweats, and weight loss, without respiratory symptoms. Imaging revealed a lytic lesion in the left ilium with surrounding sclerosis and a soft-tissue component. Biopsy confirmed coccidioidomycosis. The patient was treated with antifungals and achieved complete resolution of symptoms at 6-month follow-up.
What made this case unusual
The case is notable for the absence of antecedent pulmonary symptoms in a child with skeletal coccidioidomycosis, which is an atypical presentation of this infection.
Diagnostic / clinical pearl
Clinicians should consider coccidioidomycosis in the differential diagnosis of aggressive osseous lesions in children, especially when imaging shows lytic destruction with surrounding sclerosis.
Why it matters
Recognizing the imaging features of coccidioidomycosis can prevent misdiagnosis and reduce the risk of unnecessary interventions in pediatric patients.