B72-03 A Follow-up Failure: Valley Fever’s Hidden Path to the Spine

Abstract Introduction Coccidioidomycosis is an endemic fungal infection caused by Coccidioides immitis/posadasii, which can disseminate if inadequately treated or followed. Dissemination to the spine is rare but potentially devastating. We present a case of spinal coccidioidomycosis in a previously healthy, Spanish-speaking male requiring urgent neurosurgical intervention. Case Presentation A 44-year-old Spanish-speaking male with diabetes and a history of pulmonary coccidioidomycosis achieved partial improvement on fluconazole but was lost to follow-up. Several months later, he developed draining abscesses on the forehead, clavicle, and left axilla; cultures confirmed Coccidioides immitis/posadasii. He later presented with worsening back pain and draining lesions but was discharged without imaging.Subsequent emergency visits demonstrated a persistent right lower lobe consolidation on CT. Retrospective review of earlier scans suggested subtle lumbar changes that were initially unrecognized. With worsening symptoms, he was hospitalized with a CRP of 198 mg/L. CT revealed new lytic lesions in the right clavicle, and a right forearm abscess was incised and drained. Persistent back pain prompted an MRI, which showed extensive L1 vertebral body destruction with paraspinal and psoas abscesses. Neurosurgery performed an urgent L1 laminectomy, decompression, and T12-L2 posterior fusion. Review of prior imaging confirmed progressive L1 destruction over preceding months. Pathology revealed fungal spherules and necrosis consistent with coccidioidomycosis.He was started on intravenous liposomal amphotericin B. Further imaging at a tertiary center revealed focal skull necrosis and meningitic changes, though lumbar puncture was negative. A multidisciplinary team recommended lifelong antifungal therapy with structured follow-up and language-access support. Discussion This case underscores the severe consequences of incomplete treatment and follow-up in coccidioidomycosis. Despite initial pulmonary control, the patient developed disseminated spinal disease with vertebral destruction requiring neurosurgical decompression. Missed early radiographic signs and limited continuity of care contributed to progression. Language barriers and lack of culturally concordant follow-up likely played a key role in his loss to care and delayed recognition of dissemination. This highlights the broader impact of health disparities and communication barriers in managing complex infections. Improving access to culturally and linguistically appropriate care is essential to prevent avoidable complications in vulnerable populations. This abstract is funded by: None