PMC9826543_01
Swelling and redness on the lateral malleolus of the left ankle.
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F1
She was afebrile with stable vital signs (Fig. 1).
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.
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F2
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).
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).
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F3
However, the histopathological study revealed the presence of multinucleated giant cells, one of which has a spherule of coccidioidomycosis inside (Fig. 3).
Surgical procedure. Debridement and curettage of granuloma. Musculocutaneous flap to cover leg defect.
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F4
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).
X-ray image shows complete bone healing.
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F5
Finally, after 6 months of follow-up, all symptoms and signs of infection resolved and radiologic studies showed evidence of bone healing (Fig. 5).