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

## TL;DR

A healthy young woman developed rare fungal bone infection in her foot after an uncomplicated appendectomy, highlighting the need for considering fungal causes in treatment-resistant cases.

## Contribution

Reports a rare case of post-appendectomy fungal osteomyelitis in an immunocompetent patient.

## Key findings

- Fungal osteomyelitis due to Coccidioides species occurred after a non-complicated appendectomy.
- The patient required antifungal treatment after multiple failed antibiotic regimens.
- Fungal osteomyelitis is extremely rare in healthy patients and should be considered in treatment-resistant cases.

## Abstract

Osteomyelitis is a bone infection that presents with swelling, erythema, pain, and possible systemic symptoms. Immunocompromised patients are at higher risk of developing osteomyelitis. Fungal pathogens are a rare etiology for these infections with very few case reports published compared to infections due to bacterial pathogens. 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 fungal foot osteomyelitis after an uncomplicated appendectomy.

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.

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 physicians should maintain a high suspicion for fungal osteomyelitis when otherwise healthy patients present multiple times for failing outpatient antibiotic regimens.