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Skeletal Radiology
Published in: Skeletal Radiology 12/2019

01-12-2019 | Tuberculosis | Case Report

Spinal blastomycosis: unusual musculoskeletal presentation with literature review

Authors: Seyed Emamian, Michael G. Fox, Dustin Boatman, Felicia D. Allard, Nicholas C. Nacey

Published in: Skeletal Radiology | Issue 12/2019

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Abstract

We report a case of a 41-year-old male who presented to our institution with a large groin mass. CT, MRI and PET imaging was performed and was concerning for a soft tissue abscess likely originating in the lumbar spine. Differential considerations included infection, with atypical infections such as tuberculosis strongly considered. Biopsy revealed fungal elements preliminarily reported as consistent with Cryptococcus neoformans but later revealed to be Blastomyces dermatitidis. The patient responded positively following the introduction of appropriate treatment. This case illustrates the imaging similarities between spinal blastomycosis, spinal tuberculosis, and other fungal infections as well as the need for biopsy to differentiate.
Literature
1.
Smith JA, Kauffman CA. Blastomycosis. Proc Am Thorac Soc. 2010;7(3):173–80 Review.CrossRef
2.
3.
Saccente M, Woods GL. Clinical and laboratory update on blastomycosis. Clin Microbiol Rev. 2010;23(2):367–81 Review.CrossRef
4.
Frean JA, Carman WF, Crewe-Brown HH, Culligan GA, Young CN. Blastomycoses dermatitidis infections in the RSA. S Afr Med J. 1989;76(1):13–6.PubMed
5.
Fang W, Washington L, Kumar N. Imaging manifestations of blastomycosis: a pulmonary infection with potential dissemination. Radiographics. 2007;27(3):641–55 Review.CrossRef
6.
Lemos LB, Guo M, Baliga M. Blastomycosis: organ involvement and etiologic diagnosis—a review of 123 patients from Mississippi. Ann Diagn Pathol. 2000;4(6):391–406 Review.CrossRef
7.
Rasouli MR, Mirkoohi M, Vaccaro AR, et al. Spinal tuberculosis: diagnosis and management. Asian Spine J. 2012;6(4):294–308.CrossRef
8.
Gehweiler JA, Capp MP, Chick EW. Observations on the roentgen patterns in blastomycosis of bone: a review of cases from the Blastomycosis Cooperative Study of the Veterans Administration and Duke University Med Center. Am J Roentenol Radium Ther Nucl Med. 1970;108:497–510.CrossRef
9.
Bassett FH, Tindall JP. Blastomycosis of bone. South Med J. 1972;65:547–55.CrossRef
10.
Williams RL, Fukui MB, Meltzer CC, et al. Fungal spinal osteomyelitis in the immunocompromised patient: MR findings in 3 cases. Am J Neuroradiol. 1999;20:381–5.PubMed
11.
Moorthy S, Prabhu NK. Spectrum of MR imaging findings in spinal tuberculosis. AJR. 2002;179(4):979–83.CrossRef
12.
Kim CW, Perry A, Currier B, Yaszemski M, Garfin SR. Fungal infections of the spine. Clin Orthop Relat Res. 2006;444:92–9.CrossRef
13.
Hadjipavlou AG, Mader JT, Nauta HJ, Necessary JT, Chaljub G, Adesokan A. Blastomycosis of the lumbar spine: case report and review of the literature, with emphasis on diagnostic laboratory tools and management. Eur Spine J. 1998;7(5):416–21.CrossRef
14.
Saccente M, Abernathy RS, Pappas PG, et al. Vertebral blastomycosis with paravertebral abscess: report of 8 cases and review of the literature. Clin Infectious Dis. 1998;26(2):413–8.CrossRef
15.
Dalinka MK, Dinnenberg S, Greendyk WH, Hopkins R. Roentgenographic features of osseous coccidioidomycosis and differential diagnosis. J Bone Joint Surg Am. 1971;53:1157–64.CrossRef
16.
Mahiquez M, Bunton KL, Carney G, Weinstein MA, Small JM. Nonsurgical treatment of lumbosacral blastomycosis involving L2-S1. Spine. 2008;33:E442–6.CrossRef
17.
Güler N, Palanduz A, Ones U, al e. Progressive vertebral blastomycosis mimicking tuberculosis. Pediatr Infect Dis J. 1995;14(9):816–8.CrossRef
18.
Rammaert B, Gamaletsou MN, Zeller V, et al. Dimorphic fungal osteoarticular infections. Eur J Clin Microbiol Infect Dis. 2014;33(12):2131–40.CrossRef
19.
Goldman AB, Freiberger RH. Localized infectious and neuropathic diseases. Semin Roentgenol. 1979;14:19–32.CrossRef
20.
Sivalingham J, Kumar A. Spinal tuberculosis resembling neoplastic lesions on MRI. J Clin Diagn Res. 2015 Nov; 9(11):TC01–TC03
21.
Dimar JR 2nd, Puno RM, Nowacki MR, Carreon LY. Surgery for blastomycosis of the spine. Am J Orthop (Belle Mead NJ). 2014;43(11):E266–E271.
22.
Johansen IS, Nielsen SL, Hove M, et al. Characteristics and clinical outcome of bone and joint tuberculosis from 1994–2011: a retrospective register-based study in Denmark. Clin Infect Dis. 2015;61(4):554–62.CrossRef
23.
McClain CM, Van Horn GT, Chappell JD, Stratton CW. Coccidioides, cryptococcus, or blastomyces? A diagnostic dilemma encountered during frozen section evaluation. Pediatr Dev Pathol. 2012;15(1):71–5.CrossRef
24.
Larone DH. Medically important fungi. 5th ed. Washington, DC: ASM; 2011.
25.
Bradsher RW, Chapman SW, Pappas PG. Blastomycosis. Infect Dis Clin N Am. 2003;17(1):21–40 vii. Review.CrossRef
26.
Gottlieb JR, Eismont FJ. Nonoperative treatment of vertebral blastomycosis osteomyelitis associated with paraspinal abscess and cord compression: a case report. J Bone Joint Surg Am. 2006;88(4):854–6.PubMed
27.
Chapman SW. Blastomyces dermatitidis. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. New York: Churchill Livingstone; 2000. p. 2733–46.
Metadata
Title
Spinal blastomycosis: unusual musculoskeletal presentation with literature review
Authors
Seyed Emamian
Michael G. Fox
Dustin Boatman
Felicia D. Allard
Nicholas C. Nacey
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 12/2019
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-019-03234-9

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