BONE AND JOINT COCCIDIOIDOMYCOSIS TREATED WITH MICONAZOLE

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Abstract
Results of therapy of 31 patients with musculoskeletal coccidioidomycosis with a new antifungal drug, miconazole, are described. Results with other therapeutic modalities are poor in chronic disease and cure is rare except where radical surgery (arthrodesis, amputation) is used. The disease in the patients was largely chronic (mean duration, 34.5 mo.) and unresponsive to amphotericin B, including 17 patients with arthritis, 13 with osteomyelitis and 1 with tenosynovitis. Seven patients with arthritis, 2 with osteomyelitis and 1 with tenosynovitis responded objectively. The overall response rate was 34%. (One patient with concomitant surgery is included in the responding group.) Patients with multiple sites of bone and/or joint involvement generally failed to respond. Of those who responded, more than 1/2 relapsed subsequently. Duration of treatment of 1 mo. or less was associated with later relapse. After i.v. administration the drug penetrated well into infected joints. Local irrigation with the drug was well tolerated. Response of coexisting coccidioidal disease outside the musculoskeletal system correlated with outcome of musculoskeletal disease. Side effects of this drug were principally hyponatremia, phlebitis, anemia, nausea and pruritis and necessitated discontinuation of therapy in 5 patients. No nephrotoxicity was seen and all side effects were reversible on stopping the drug. The relative role of amphotericin B and miconazole therapy in this disease remains to be determined.

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