An Unusual Case Of Chronic Knee Pain In A Mountain Biker

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An Unusual Case Of Chronic Knee Pain In A Mountain Biker - Page #4

Working Diagnosis: Coccidioidomycosis of the left knee Treatment: Patient underwent radical resection of the left popliteal mass by orthopedic oncology. Infectious disease initiated fluconazole 800mg daily for 1 year, patient was also recommended to have a chest x-ray which was negative. Outcome: Patient followed up periodically with infectious disease for complement fixation titers which improved. At follow up with orthopedic oncology, he endorsed gradual improvement of his symptoms. Patient continues to bike, now utilizing an e-bike. He was encouraged to wear a knee brace during running, hiking and biking. He will follow up with orthopedics as needed. Author's Comments: Patient had been treated for presumed popliteal cyst, however serial MRIs and worsening symptoms prompted further workup revealing coccidioidomycosis, in which patient was started on antifungal therapy with improvement in his symptoms. It is important to consider coccidioidomycosis as a possible etiology for chronic joint pain and swelling in patients from or traveling to endemic areas. Editor's Comments: Coccidiomycosis is a fungal infection that primarily causes pulmonary disease. Extrapulmonary dissemination can occur to the musculoskeletal system with the knee joint most frequently involved. Coccidiomycosis should be considered in a differential diagnosis of patients with popliteal cysts without other obvious etiologies, especially if the patient has spent time in the endemic area of Southwestern US and Central and South America. References: Arthroscopy.1998 Jan-Feb;14(1):99-102. doi: 10.1016/s0749-8063(98)70130-6 Orthopedics. 2014 Aug;37(8):e678-84. doi: 10.3928/01477447-20140728-52 Infect Dis Clin North Am. 2021 Jun;35(2):453-469. doi: 10.1016/j.idc.2021.03.010 Return To The Case Studies List.		Back
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