In patients with coccidioidomycosis, 10-20% will develop granulomatous lesions in the skeleton. Often times, skeletal infection is bilateral and somewhat symmetric, as is the case in this patient. Some authors have described a predilection for bony protuberances with the granulomatous lesions, which is also noted in this case. Lesions are typically well defined, usually without periostitis, sclerosis or seqeuestra formation, which remains true for all of the lesions seen here. ¹