case_images: PMC9826543_01
case_images: Swelling and redness on the lateral malleolus of the left ankle.
case_images: JOCR-12-66-g001.jpg
case_images: PMC9826543_01_JOCR-12-66-g001.jpg
case_images: F1
case_images: She was afebrile with stable vital signs (Fig. 1).
case_images: X-ray. A lytic well-defined image is observed in the distal tibial metaphysis. Magnetic resonance imaging shows a hyperintense metaphyseal mass with extension to the growth physis, suggestive of osteomyelitis.
case_images: JOCR-12-66-g002.jpg
case_images: PMC9826543_01_JOCR-12-66-g002.jpg
case_images: F2
case_images: Imaging studies were indicated in which a well-defined lesion with a lytic appearance was observed in the distal metaphyseal region of the left tibia (Fig. 2). Given the possibility of a tumor disease, a magnetic resonance image was carried out, and a hyperintense metaphyseal mass was reported magnetic resonance imaging with extension to the growth physis, suggestive of osteomyelitis (Fig. 2).
case_images: An image intensifier shows the biopsy procedure. Histological sections. Hematoxylin and eosin (H&E) revealed multinucleated giant cells and spherules of coccidiodes immitis (White and black arrows, x40).
case_images: JOCR-12-66-g003.jpg
case_images: PMC9826543_01_JOCR-12-66-g003.jpg
case_images: F3
case_images: However, the histopathological study revealed the presence of multinucleated giant cells, one of which has a spherule of coccidioidomycosis inside (Fig. 3).
case_images: Surgical procedure. Debridement and curettage of granuloma. Musculocutaneous flap to cover leg defect.
case_images: JOCR-12-66-g004.jpg
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case_images: F4
case_images: Surgical debridement and curettage of the granuloma in the distal tibia were performed and an advancement flap was made to cover the skin defect (Fig. 4).
case_images: X-ray image shows complete bone healing.
case_images: JOCR-12-66-g005.jpg
case_images: PMC9826543_01_JOCR-12-66-g005.jpg
case_images: F5
case_images: Finally, after 6 months of follow-up, all symptoms and signs of infection resolved and radiologic studies showed evidence of bone healing (Fig. 5).