2019 Research Forum

Applicant: Manasa Kalluri MD R1 Principal Investigator & Faculty Sponsor: Arash Heidari MD

Multifocal Osseous Coccidioidomycosis Masquerading as Multiple Myeloma

Carlos D’Assumpcao MD R1, Emily Gunz MS IV, Jessica McFarland MS IV, Leila Moosavi MD R3, Matthew Gilbert MS IV, Amit Sah MS IV, Manasa Kalluri MD R1, Janushe Patel MD MPH, Arash Heidari MD

INTRODUCTION Coccidioidomycosis is a fungal infection of Coccidioides immitis or posidosii endemic to the southwest United States that commonly manifests in the lung but can disseminate to bone and other tissues. Multiple myeloma is a cancer of plasma cells that present as lytic bone lesions in the spine and skull. Presentation can be confused.

PURPOSE We present a case of osseous coccidioidomycosis that initially presented with lytic bone lesions.

DISCUSSION Incidental lytic bone lesions are typically pathognomonic for bone or bone marrow related malignancies or metastasis with age-related differential diagnoses. Axial lytic bone lesions with anemia and weight loss in the middle aged may initially suggest multiple myeloma. Osseous coccidioidomycosis is an uncommon site of dissemination for Coccidioides. Untreated it can be debilitating with pathological fractures in critical regions such as the cervical spine. Lesion proximity to the meninges should prompt evaluation for meningitis, one of the most devastating sites of dissemination. Risk factors for dissemination are not yet established. Thorough aggressive investigation with multiple imaging and laboratory modalities can guide treatment aggressiveness and estimate prognosis. Unfortunately, social determinants of health such as homelessness, drug abuse, and financial constraints may hamper even the best intended interventions.

CONCLUSION Physicians in areas endemic for coccidioidomycosis should be aware of atypical presentation of dissemination that may masquerade as other more commonly described diseases.

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