• Larissa A Szeyko, Mihra S Taljanovic, Robert B Dzioba, Jennifer L Rapiejko, and Rodney D Adam.
• Infectious Disease Section, University of Arizona College of Medicine, Tucson, 85724-5039, USA.
• Am. J. Med. 2012 Mar 1; 125 (3): 304314304-14.

BackgroundVertebral involvement is a severe complication of infection caused by Coccidioides species.MethodsWe conducted a retrospective review of patients diagnosed with vertebral coccidioidomycosis at an academic medical center between 1996 and 2009.ResultsWe identified 39 cases of vertebral coccidioidomycosis. Thirty-four patients (79%) were male, and 23 patients (61%) were black. Black patients were overrepresented in comparison with all other patients by a 50-fold odds ratio (95% confidence interval, 26-95). Only 8 patients (20%) were immunocompromised, including 7 who had received systemic steroids. The number of infected vertebrae ranged from 1 to 24; 8 patients (21%) had epidural involvement. All patients received a triazole as part of medical therapy, and 20 patients also received amphotericin B, typically early in the course. Twenty-six patients (67%) required surgery, 18 of whom also required hardware placement. The most common indication for surgery was pain, but 7 patients had neurologic compromise. No patients developed recurrent or refractory infection at the site of surgical debridement, but 6 patients experienced disease relapse after stopping antifungal therapy.ConclusionVertebral infection caused by Coccidioides species requires a multispecialty approach that always includes medical therapy and frequently requires surgical intervention for debridement or stabilization. A favorable outcome can usually be achieved, but discontinuation of medical therapy is associated with a high risk of relapse, which can occur years later.Copyright © 2012 Elsevier Inc. All rights reserved.

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