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Coccidioides, cryptococcus, or blastomyces? A diagnostic dilemma encountered during frozen section evaluation
Colt M McClain1, Gerald T Van Horn, James D Chappell
1Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA. colt.m.mcclain@vanderbilt.edu
Summary
Frozen sections aid in diagnosing fungal osteomyelitis but may not precisely identify the specific fungus. Intraoperative cultures are crucial for accurate identification, distinguishing between agents like Blastomyces and Coccidioides.
Area of Science:
- Surgical Pathology
- Mycology
- Infectious Diseases
Background:
- Intraoperative frozen sections are vital for surgical pathology, yet fungal identification can be challenging.
- Accurate diagnosis of fungal osteomyelitis requires careful microscopic evaluation and often further testing.
Observation:
- A case of chronic osteomyelitis in a 17-year-old boy initially suspected as Coccidioides based on frozen section findings.
- Subsequent permanent sections with special stains and fungal culture confirmed Blastomyces dermatitidis as the causative agent.
Findings:
- Frozen sections are valuable for assessing morphology and infectious processes, providing a differential diagnosis for fungi.
- Distinguishing between fungal species like Blastomyces, Coccidioides, and Cryptococcus requires comprehensive analysis beyond initial frozen section.
Implications:
- The study highlights the limitations of frozen sections in definitive fungal speciation.
- Emphasizes the critical role of intraoperative cultures and pathologist-surgeon communication for accurate diagnosis and treatment of fungal infections.
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