BMJ Case Reports 2018; doi:10.1136/bcr-2017-222585
  • Unusual presentation of more common disease/injury

Coccidioides immitis septic knee arthritis

  1. Scott A Weisenberg
  1. Department of Medicine, New York University School of Medicine, New York, USA
  1. Correspondence to Dr Scott A Weisenberg, scott.weisenberg{at}
  • Accepted 22 February 2018
  • Published 13 March 2018


A 78-year-old man developed right knee pain and swelling without other systemic symptoms. He had travelled frequently to the Central Valley of California. He was diagnosed with coccidioidomycosis based on joint fluid culture. Coccidioidal complement fixation antibody titres were extremely elevated. Arthroscopic debridement and fluconazole therapy did not lead to satisfactory improvement. Subsequent open debridement and change to itraconazole was followed by resolution of clinical signs of infection.


  • Contributors SAW prepared the manuscript without assistance.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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