A review of twelve cases in which disseminated coccidioidomycosis caused
localized infection of the spine showed that eight of the twelve patients
were alive and well with no evidence of active infection an average of
eleven years after onset (range, two to thirty-five years). One patient who
was followed for more than twenty-three years had a slowly developing
neurological impairment in the lower extremities as a result of
lumbosarcral destruction instability. One patient died early in the course
of the disease from fulminating cervical spondylitis and quadriplegia. A
second patient had a paraplegia from thoracic spondylitis. On patient had
no evidence of active spondylitis five years after the onset of the
disease, but then died of coccidioidal meningitis. All patients were
treated with intravenous amphotericin at some time in the course of their
illness, although its effect was not always dramatic. The three patients
with neurological impairment did not undergo spine fusion, but most of the
others had that operation. Surgical evacuation of abscesses and debridement
of infected bone was also performed in many cases.