Case Report of Post-Appendectomy Fungal Osteomyelitis: A Rare Complication in a Healthy Patient

Introduction: Osteomyelitis is a bone infection that presents with swelling, erythema, pain, and possible systemic symptoms.  Immunocompromised patients are at higher risk of developing osteomyelitis.  While bacterial osteomyelitis is the most common source causing infection, fungal osteomyelitis is even more uncommon with very few case reports published.  Work up should include imaging studies to investigate infections when there is clinical suspicion for osteomyelitis.  Bone biopsy is performed to identify the causative agent with bacterial infections being the most common.  Osteomyelitis can be treated both surgically with debridement or amputation and medically with extended courses of antimicrobials or antifungals.  Our case describes acute onset fungal foot osteomyelitis after an uncomplicated appendectomy. Case Report: A 19-year-old previously healthy female underwent laparoscopic appendectomy for nonperforated, non-gangrenous appendicitis.  Fourteen days later, she developed gradually worsening right foot pain, swelling, and erythema.  After multiple failed treatments for the management of osteomyelitis, bone biopsies and courses of antibiotics, patient was ultimately diagnosed with a rare osteomyelitis secondary to Coccidioides species, which was managed and improved with antifungals.Conclusion: Bacterial osteomyelitis has been described in two English case reports as a postoperative complication of appendectomy, particularly when the appendicitis is perforated, gangrenous or purulent.  Fungal osteomyelitis is an even rarer cause of postoperative bone infection in immunocompetent patients.  The goal for treatment is surgical intervention or pharmacologic management.  Emergency Department practitioners should maintain a high suspicion for fungal osteomyelitis in otherwise healthy patients presenting with musculoskeletal complaints, and should consider the possibility of fungal species as the cause.