Presentation
Presents with 6-month history of lameness and recent firm swelling on the right hind limb.
Patient Data
Three sets of images are available for review. The first of each group of three images is at presentation, and the second and third are two and eight month recheck intervals.
There are mixed productive and destructive bone lesions in the proximal tibia, greater trochanter of the right femur, and proximal right humerus. The lesions are mainly composed of medullary sclerosis which is progressive over time. There is also increased soft tissue opacity within the stifle joint surrounding the tibial lesion. There are multiple punctate lucencies in the femoral and tibial lesions in the last series. There is smooth periosteal new bone surrounding the greater trochanter of the right femur.
Case Discussion
Polyostotic aggressive bone lesions are consistent with fungal osteomyelitis such as coccidioidomycosis. No pulmonary involvement was identified.
A titer confirmed coccidioidomycosis. The dog was treated with itraconozole and had radiographic improvement of some of the lesions over 8 months. However, intermittent lameness recurred over the next several years. Titers returned to normal and clinical resolution occurred after three years.
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