Background: Coccidioidomycosis is an endemic fungal infection in the southwestern of United States. Most\r\ninfections are asymptomatic or manifest with mild respiratory complaints. Rare cases may cause extrapulmonary or\r\ndisseminated disease. We report two cases of knee involvement that presented as isolated lytic lesions of the\r\npatella mimicking neoplasms.\r\nCase Presentation: The first case, a 27 year-old immunocompetent male had progressive left anterior knee pain for\r\nfour months. The second case was a 78 year-old male had left anterior knee pain for three months. Both of them\r\nhad visited general physicians without conclusive diagnosis. A low attenuation lytic lesion in the patella was\r\ndemonstrated on their image studies, and the initial radiologist�s interpretation was suggestive of a primary bony\r\nneoplasm. The patients were referred for orthopaedic oncology consultation. The first case had a past episode of\r\npulmonary coccioidomycosis 2 years prior, while the second case had no previous coccioidal infection history but\r\nlived in an endemic area, the central valley of California. Surgical biopsy was performed in both cases due to\r\ndiagnostic uncertainty. Final pathologic examination revealed large thick walled spherules filled with endospores\r\nestablishing the final diagnosis of extrapulmonary coccidioidomycosis.\r\nConclusions: Though history and laboratory findings are supportive, definitive diagnosis still depends on growth in\r\nculture or endospores identified on histology. We suggest that orthopaedic surgeons and radiologists keep in mind\r\nthat chronic fungal infections can mimic osseous neoplasm by imaging.
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