title: Osteomyelitis and pyoarthritis resulting from local paracoccidioidomycosis in an immunocompetent patient: a case report.
abstract: BACKGROUND
  Paracoccidioidomycosis is a type of mycosis that is endemic to Brazil and is triggered by the fungus Paracoccidioides brasiliensis. Isolated bone involvement in this disease is very rare, especially in children. To the best of our knowledge this report documents the first case of an immunocompetent pediatric patient in which paracoccidioidomycosis of the hip articulation was the sole manifestation of the disease (that is, there were no pulmonary or skin lesions).
  
  
  METHODS
  An 11-year-old Brazilian Caucasian boy from a rural area was examined in the orthopedic ward of our emergency department. Our patient reported a three-month history of pain in the right hip with intermittent claudication and also complained of recurring episodes of intense pain and an inability to walk, which he had been experiencing for the previous five days. He additionally presented with a fever that had persisted for two days. Our patient's medical history did not include any clinical respiratory manifestations, skin lesions, history of trauma or immunosuppression risk factors.
  
  
  CONCLUSIONS
  This is one of the very few reported cases of isolated articular involvement in osteomyelitis in a pediatric immunocompetent patient. Paracoccidioidomycosis should be considered among the differential diagnoses in such cases, especially in cases of patients who reside in rural areas where the condition is considered to be endemic, in order to administer the proper course of treatment in a timely fashion and improve the chances of a favorable prognosis.
authors.affiliation: Radiology, Hospital do Servidor Público Estadual (HSPE/IAMSPE), São Paulo, SP, Brasil. furtadoleofreitas@hotmail.com.
authors.forename: Michel Santana
authors.initials: MS
authors.lastname: Michelan
authors.forename: Eloy de Avila
authors.initials: Ede A
authors.lastname: Fernandes
authors.forename: Leonardo Furtado
authors.initials: LF
authors.lastname: Freitas
authors.forename: Rodrigo Hoeller
authors.initials: RH
authors.lastname: Ribeiro
authors.forename: Marília Magri
authors.initials: MM
authors.lastname: Milano
authors.forename: Soraya Silveira
authors.initials: SS
authors.lastname: Monteiro