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PT  - JOURNAL ARTICLE
AU  - Crete, R.N.
AU  - Gallmann, W.
AU  - Karis, J.P.
AU  - Ross, J.
TI  - Spinal Coccidioidomycosis: MR Imaging Findings in 41 Patients
AID  - 10.3174/ajnr.A5818
DP  - 2018 Nov 01
TA  - American Journal of Neuroradiology
PG  - 2148--2153
VI  - 39
IP  - 11
4099  - http://www.ajnr.org/content/39/11/2148.short
4100  - http://www.ajnr.org/content/39/11/2148.full
SO  - Am. J. Neuroradiol.2018 Nov 01; 39
AB  - BACKGROUND AND PURPOSE: Coccidioides immitis is a dimorphic fungus endemic to the Southwest United States and Mexico, and at our institution, it is a relatively common pathogen presenting with a broad spectrum of associated spine diseases. We describe the various spinal manifestations resulting from coccidioidal infection and provide MR imaging examples from 41 pathologically proved cases.MATERIALS AND METHODS: Retrospective electronic medical record and PACS searches were performed. Patients found to have both MR imaging findings positive for infection and confirmative biopsy and/or CSF studies were included. Abnormal MR imaging findings were identified, categorized, and quantified. Patient demographics and associated intracranial involvement if present were also recorded.RESULTS: Forty-one patients were included. Positive findings were categorized as leptomeningeal enhancement (26 patients, 63%), arachnoiditis (22 patients, 54%), osteomyelitis-discitis (14 patients, 34%), cord edema (11 patients, 27%), and true syrinx (3 patients, 7%). Thirty patients had documented brain involvement (73%), most commonly in the form of basilar meningitis. Four patients were positive for HIV (10%). Fifteen patients had pulmonary manifestations at presentation (37%).CONCLUSIONS: C immitis results in various spinal manifestations, most commonly leptomeningeal enhancement and arachnoiditis/adhesive disease followed by osteomyelitis, which may resemble tuberculous or pyogenic infection on MR imaging.T1+CT1-weighted images with contrast