Coccidioidomycosis of the first cuneiform: successful treatment utilizing local debridement and long-term ketoconazole therapy.

Although intravenous amphotericin B is generally considered to be the standard treatment for coccidioidomycosis, the treatment of monostotic coccidioidomycosis is controversial. Long-term intravenous and oral antifungal chemotherapy has been utilized alone and in conjunction with local surgical debridement. We present a case of coccidioidal osteomyelitis of a tarsal bone successfully treated with local surgical debridement and oral ketoconazole and propose clinical guidelines for selecting the proper chemotherapeutic agent and for following the efficacy of the treatment regimen.