Intramedullary blastomycosis in a child: case report.
OBJECTIVE
To report a case of spinal intramedullary blastomycosis causing myelopathy.


METHODS
An otherwise healthy 13-year-old patient was diagnosed with respiratory North American blastomycosis. She subsequently received a five-month course of itraconazole with presumed resolution of the infection. The patient presented again at 14 years of age with a lumbar myelopathy. Magnetic resonance imaging revealed an intramedullary lesion of 1 cm diameter at the level of T12-L1.


METHODS
A T12-L1 laminectomy was performed with a gross total resection of the lesion. Pathological examination and microbiological culture of the specimen was consistent with blastomycosis. Postoperatively, the patient was placed on a five week course of amphotericin B. The patient showed substantial improvement in neurological function.


CONCLUSIONS
Blastomycosis can present as an isolated intramedullary lesion causing compromised function. It should be considered in the differential diagnosis of a patient with a myelopathy and previously recognized blastomycosis. The prognosis is good with surgical resection.
Parr
A M
AM
Division of Neurosurgery, University of Manitoba, Winnipeg, MB, Canada.
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D000293:Adolescent; D000666:Amphotericin B / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001758:Blastomyces / Q000302:isolation & purification; D001759:Blastomycosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D005260:Female; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D010000:Osteitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D016896:Treatment Outcome
D000935:Antifungal Agents; C041989:amphotericin A; D000666:Amphotericin B