Case report: blastomycosis causing sciatic neuritis

A patient presented with pain in the right lower back, radiating down the right leg. Initial pelvic X-rays did not reveal any lesion. A follow up computerized tomography (CT) scan and technitium scan showed a sharply lytic lesion of the right ilium extending to the right sacroiliac joint. Open biopsy revealed a granulomatous inflammation with many budding yeast from consistent with Blastomyces dermatitidis. Subsequent culture confirmed this identification. There was no other site of fungal infection. Two courses of Amphotericin B (each to 2 g total dose) failed to eradicate this infection. The patient is now responding to Ketoconazole.