Nonoperative Treatment of Vertebral Blastomycosis Osteomyelitis Associated with Paraspinal Abscess and Cord Compression: A Case Report

Abstract

Fungal infections of the spine are uncommon and usually result from hematogeneous spread of a primary focus1. Blastomyces dermatitidis has been described as a causative agent in cases of vertebral osteomyelitis2,3. Most cases of blastomycosis osteomyelitis begin as primary fungal infections of the lungs3. However, traumatic innoculation, local extension, and lymphatic spread also have been described as possible mechanisms of introduction of the fungi to bone2. The long bones are more commonly affected than the vertebral column is4. Primary cutaneous blastomycosis can occur5, and many other organ systems, including the genitourinary and central nervous systems, can be affected6. Blastomyces dermatitidis is a dimorphic fungus endemic to the southeastern and south central portions of the United States4. Primary pulmonary blastomycosis is acquired by inhalation of airborne conidia1. The spores then develop into the yeast form, producing an acute illness stage that is clinically indistinguishable from a bacterial pneumonia. In as many as 50% of cases of disseminated blastomycosis, osseous involvement may occur2,7. We report the case of a patient in whom vertebral blastomycosis osteomyelitis was successfully treated nonoperatively. The patient was informed that information concerning this case would be submitted for publication. Asixty-four-year-old South American woman who had recent-onset midthoracic spinal pain with left scapular radiation presented to us in February 2001. The patient had no history of trauma or recent illness and no history of exposure to farm animals or pets. The medical history included chronic hypertension, arthritis, and depression. Physical examination revealed normal findings. A computerized tomography scan demonstrated a paraspinal mass with rim …