A Young Man with Fever and Back Pain

Abstract

A 25-year-old man presented to a midwestern emergency department with a 3-month history of back and right hip pain accompanied by 9 kg of weight loss. His history was significant for completed treatment of pulmonary blastomycosis 2 years prior. On examination, he was febrile and tachycardic, with tenderness of the lumbar spine and right hip. Chest radiograph revealed miliary pulmonary nodules (Figure 1), which were redemonstrated on computed tomography of the chest (Figure 2). Computed tomography imaging of his abdomen and pelvis demonstrated multiple lytic bone lesions of the axial skeleton (Figures 3 and 4), with adjacent abscesses in the lumbar paraspinal musculature.