title: Case 209: Disseminated coccidioidal spondylodiskitis.
abstract: History A 46-year-old Hispanic man with a medical history of diabetes and hepatitis C and an unclear history of prior infectious disease presented to the emergency department of a community medical center in the northeastern United States with a 3-month history of back pain. The patient was originally from Mexico and had been living in the United States for approximately 1 year. Physical examination at the time of admission was noncontributory. Pertinent hematologic laboratory test results were as follows: white blood cell count, 11.2 ×10(9)/L (normal range, [4.5-11.0] ×10(9)/L); neutrophil level, 81.3% (0.81) (normal range, 38.9%-75.1% [0.39-0.75]); hemoglobin level, 7.9 g/dL (normal range, 13.5-18.0 g/dL); hematocrit level, 23.2% (0.23) (normal range, 40.0%-54.0% [0.40-0.54]); and calcium level, 8.3 mg/dL (2.07 mmol/L) (normal range, 8.4-10.4 mg/dL [2.1-2.6 mmol/L]). Protein electrophoresis revealed hypergammaglobulinemia consistent with chronic inflammation. Relevant radiologic studies included computed tomography (CT) and magnetic resonance (MR) imaging of the spine.
authors.affiliation: From the Department of Radiology, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554.
authors.forename: Brandon D
authors.initials: BD
authors.lastname: Mirochnik
authors.forename: Steven
authors.initials: S
authors.lastname: Lev
authors.forename: Ephram P
authors.initials: EP
authors.lastname: Weingarten
mesh_terms: D003047:Coccidioidomycosis / Q000175:diagnosis*; D003937:Diagnosis, Differential; D015299:Discitis / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D016103:Spinal Fractures / Q000175:diagnosis*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods