Two Cases Illustrating the Diagnostic Challenge of Pediatric Blastomycosis Presenting as Osteomyelitis. Issue 10 (October 2020)

• Record Type: Journal Article
• Authors: Gusland, Danièle Y.; Livermore, Andrew T.; Sterkel, Alana K.; Nguyen, Jie C.; Conway, James H.
• Is Part Of: Pediatric emergency care. Volume 36:Issue 10(2020)
• Publication Date: 2020-10
• Subjects: osteomyelitis -- blastomycosis -- Blastomyces; Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000002084
• Languages: English
• ISSNs: 0749-5161

Abstract

Abstract : Abstract: Blastomyces dermatitidis is a dimorphic fungus endemic to the United States and Canada. Although both Histoplasma and Blastomyces are found in similar geographic regions, Blastomyces is many times more likely to cause dissemination in the immunocompetent host, frequently involving the bone. However, given the indolent nature of this fungal infection and more prevalent bacterial etiologies of osteomyelitis, diagnosis and treatment are often significantly delayed. We review 2 pediatric cases that initially presented with isolated orthopedic symptoms without documented fever or pulmonary complaints, although both had signs of pulmonary infection on imaging. These cases demonstrate the importance of a high level of suspicion as well as appropriate diagnostic workup, including surgical pathology with fungal stains, when evaluating osteomyelitis in patients exposed to a Blastomyces -endemic region.