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Blastomycosis of long bones
Paul Saiz1, Steven Gitelis, Walter Virkus
1Flagstaff Center for Bone and Joint Disorders Flagstaff, AZ 86001, USA. paiulsaizmd@fcbj.com
Clinical Orthopaedics and Related Research
|May 5, 2004
Summary
Blastomycosis osteomyelitis often mimics bone cancer, causing diagnostic delays. Early recognition and antifungal treatment lead to excellent outcomes, making it crucial to include fungal infections in bone tumor differential diagnoses.
Area of Science:
- Medical Mycology
- Skeletal Radiology
- Infectious Diseases
Background:
- Blastomycosis presents nonspecifically, frequently misdiagnosed as neoplasm.
- Osseous blastomycosis symptoms include pain and swelling, with radiographic findings often mistaken for bone tumors.
- Delayed diagnosis is common, impacting patient management and outcomes.
Purpose of the Study:
- To highlight the diagnostic challenges of blastomycosis osteomyelitis.
- To emphasize the importance of considering endemic fungal infections in bone tumor differential diagnoses.
- To review treatment outcomes for blastomycosis osteomyelitis.
Main Methods:
- Retrospective case review of five patients initially diagnosed with bone tumors.
- Analysis of clinical presentation, radiographic findings, diagnostic timelines, and treatment protocols.
- Functional assessment using Musculoskeletal Tumor Society scoring.
Main Results:
- Average diagnostic delay was 4.7 months.
- Radiographic findings evolved from normal/osteopenia to lucent lesions.
- Treatment with surgical debridement and antifungals resulted in disease resolution.
- Mean functional score was 93.3%.
Conclusions:
- Blastomycosis osteomyelitis requires inclusion in the differential diagnosis of bone tumors.
- Prompt diagnosis and appropriate antifungal therapy are key to successful treatment.
- Cultures from biopsy specimens are essential for all suspected neoplasms.