Delayed treatment of pulmonary blastomycosis causing vertebral osteomyelitis, paraspinal abscess, and spinal cord compression.
A 36-year-old woman with gallbladder disease had an incidental finding of asymptomatic cavitary lung infection with Blastomyces dermatitidis. No treatment was given initially, and 2 months later she presented with vertebral osteomyelitis, paraspinal abscess, and spinal cord compression due to dissemination of the fungus. The patient recovered following surgical debridement and treatment with 1 g of amphotericin B, followed by itraconazole 400 mg QD for 6 months. In spite of previous reports of the self limiting nature of primary pulmonary blastomycosis in the normal host, antifungal therapy may be needed in cases that do not resolve spontaneously within a short period of time, or if transient immunosuppression may be anticipated as may occur following surgery or after acquisition of other infections.
Lagging
L M
LM
Division of Infectious Diseases and Immunology, Saint Louis University School of Medicine, Missouri 63104.
Breland
C M
CM
Kennedy
D J
DJ
Milligan
T W
TW
Sokol-Anderson
M L
ML
Westblom
T U
TU
D000038:Abscess / Q000382:microbiology*; D000328:Adult; D001759:Blastomycosis / Q000382:microbiology*; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000382:microbiology*; D008279:Magnetic Resonance Imaging; D010019:Osteomyelitis / Q000382:microbiology*; D013117:Spinal Cord Compression / Q000382:microbiology*; D013122:Spinal Diseases / Q000382:microbiology*; D013904:Thoracic Vertebrae / Q000382:microbiology; D014057:Tomography, X-Ray Computed