389. Pediatric Musculoskeletal Coccidioidomycosis in Central California: Single-Center Experience

BACKGROUND: Coccidioidomycosis is an infection caused by the fungus Coccidioides (cocci), endemic to the southwest region of the United States. The burden of coccidioidomycois in Central California continues to be significant among children. Limited published literature on disseminated coccidioidomycosis, including musculoskeletal coccidioidomycosis (MSKC) currently exists. METHODS: Describe the clinical course and outcomes of MSKC in a tertiary children’s hospital. RESULTS: Thirty cases were identified. Median age was 13.1 years (IQR, 5.1–14.5). Majority was male (63%), Hispanic (63%), and without comorbid conditions (70%). Common presenting features included limb swelling (60%), bony pain (50%), joint pain (43%), and fever (40%), and the majority of patients were hospitalized (90%). Pulmonary disease occurred in 57%, and 7% had meningitis. Cocci EIA antibody was positive in 63% and 90% were positive by Immunodiffusion; median serum cocci complement fixation (CF) titers were 1:128 (IQR, 64–512). Tissue/fluid culture was positive in 92%. The most commonly involved bony sites were: Craniofacial (33%), vertebrae (17%), and rib (13%). Most required surgery (77%) and 39% underwent ≥2 procedures. Twenty-six patients (86%) required ≥2 antifungal therapies with median duration of 2 years (IQR, 1.7–2.6). Overall, 83% had resolved and/or stable disease, whereas 17% experienced relapse and/or progressive disease. Additionally, older patients (≥13 years) were more likely to have two or more procedures as compared with younger patients (78% vs. 22%, P = 0.03). Trend toward higher cocci CF titers was also seen in older patients as compared with younger ones (1:256 vs. 1:64). CONCLUSION: To our knowledge, this is the largest case series of MSKC. Older patients seem to be at high risk for MSKC with more aggressive disease requiring multiple surgeries. Any musculoskeletal symptoms or high cocci CF titers should prompt early consideration and evaluation, including skeletal scintigraphy and MRI of involved area, especially in an endemic region. DISCLOSURES: All authors: No reported disclosures.