Histoplasma Osteomyelitis Simulating Giant-Cell Tumor of the Distal Part of the Radius

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Histoplasmosis is a ubiquitous fungal infection endemic to many regions in North America. Mild pulmonary infection with Histoplasma capsulatum is common, but musculoskeletal involvement is rare. We report a case of isolated Histoplasma osteomyelitis presenting as giant-cell tumor of the distal part of the radius. We found no other reported case of histoplasmosis masquerading as giant-cell tumor or of isolated Histoplasma osteomyelitis in a young, healthy patient. The patient was informed that data concerning the case would be submitted for publication, and he consented; our institutional review board exempts case reports from the approval process. A thirty-three-year-old, right-hand-dominant, otherwise healthy man presented to the orthopaedic clinic with an approximately three-month history of pain in the left wrist. The patient denied any history of recent trauma to the extremity and reported no respiratory or systemic illness preceding the wrist pain. The medical history was notable only for an uneventful recovery following a gunshot wound to the left second metacarpal years earlier. He reported no fever, chills, or other constitutional symptoms and had recently screened negative for the human immunodeficiency virus (HIV). He had moved back to Memphis, Tennessee, six years before presentation after having lived in Dallas, Texas, for several years. Physical examination revealed that the patient was afebrile and that the vital signs were within normal limits. Examination of the left wrist revealed tenderness to palpation over the distal part of the radius but no palpable masses or overlying skin changes. The patient had full range of motion of the wrist. He was neurologically intact and had a palpable radial pulse. The white blood-cell count was 3600 μL (3.6 × 109/L), and the hematocrit was 39%. Radiographs of the wrist demonstrated a radiolucent lesion in the lateral aspect of the distal radial epiphysis, with sharp borders and mild …