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Fungal osteomyelitis with vertebral re-ossification

INTRODUCTION: We present a rare case of thoracic vertebral osteomyelitis secondary to pulmonary Blastomyces dermatitides. PRESENTATION OF CASE: A 27-year-old male presented with three months of chest pains and non-productive cough. Examination revealed diminished breath sounds on the right. CT/MR im...

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Autores principales: O′Guinn, Devon J., Serletis, Demitre, Kazemi, Noojan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756086/
https://www.ncbi.nlm.nih.gov/pubmed/26692163
http://dx.doi.org/10.1016/j.ijscr.2015.11.031
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author O′Guinn, Devon J.
Serletis, Demitre
Kazemi, Noojan
author_facet O′Guinn, Devon J.
Serletis, Demitre
Kazemi, Noojan
author_sort O′Guinn, Devon J.
collection PubMed
description INTRODUCTION: We present a rare case of thoracic vertebral osteomyelitis secondary to pulmonary Blastomyces dermatitides. PRESENTATION OF CASE: A 27-year-old male presented with three months of chest pains and non-productive cough. Examination revealed diminished breath sounds on the right. CT/MR imaging confirmed a right-sided pre-/paravertebral soft tissue mass and destructive lytic lesions from T2 to T6. CT-guided needle biopsy confirmed granulomatous pulmonary Blastomycosis. Conservative management with antifungal therapy was initiated. Neurosurgical review confirmed no clinical or profound radiographic instability, and the patient was stabilized with TLSO bracing. Serial imaging 3 months later revealed near-resolution of the thoracic soft tissue mass, with vertebral re-ossification from T2 to T6. DISCUSSION: Fungal osteomyelitis presents a rare entity in the spectrum of spinal infections. In such cases, lytic spinal lesions are classically seen in association with a large paraspinous mass. Fungal infections of the spinal column may be treated conservatively, with surgical intervention reserved for progressive cases manifesting with neurological compromise and/or spinal column instability. Here, we found unexpected evidence for vertebral re-ossification across the affected thoracic levels (T2-6) in response to IV antibiotic therapy and conservative bracing, nearly 3 months later.
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spelling pubmed-47560862016-03-02 Fungal osteomyelitis with vertebral re-ossification O′Guinn, Devon J. Serletis, Demitre Kazemi, Noojan Int J Surg Case Rep Case Report INTRODUCTION: We present a rare case of thoracic vertebral osteomyelitis secondary to pulmonary Blastomyces dermatitides. PRESENTATION OF CASE: A 27-year-old male presented with three months of chest pains and non-productive cough. Examination revealed diminished breath sounds on the right. CT/MR imaging confirmed a right-sided pre-/paravertebral soft tissue mass and destructive lytic lesions from T2 to T6. CT-guided needle biopsy confirmed granulomatous pulmonary Blastomycosis. Conservative management with antifungal therapy was initiated. Neurosurgical review confirmed no clinical or profound radiographic instability, and the patient was stabilized with TLSO bracing. Serial imaging 3 months later revealed near-resolution of the thoracic soft tissue mass, with vertebral re-ossification from T2 to T6. DISCUSSION: Fungal osteomyelitis presents a rare entity in the spectrum of spinal infections. In such cases, lytic spinal lesions are classically seen in association with a large paraspinous mass. Fungal infections of the spinal column may be treated conservatively, with surgical intervention reserved for progressive cases manifesting with neurological compromise and/or spinal column instability. Here, we found unexpected evidence for vertebral re-ossification across the affected thoracic levels (T2-6) in response to IV antibiotic therapy and conservative bracing, nearly 3 months later. Elsevier 2015-12-08 /pmc/articles/PMC4756086/ /pubmed/26692163 http://dx.doi.org/10.1016/j.ijscr.2015.11.031 Text en © 2015 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
O′Guinn, Devon J.
Serletis, Demitre
Kazemi, Noojan
Fungal osteomyelitis with vertebral re-ossification
title Fungal osteomyelitis with vertebral re-ossification
title_full Fungal osteomyelitis with vertebral re-ossification
title_fullStr Fungal osteomyelitis with vertebral re-ossification
title_full_unstemmed Fungal osteomyelitis with vertebral re-ossification
title_short Fungal osteomyelitis with vertebral re-ossification
title_sort fungal osteomyelitis with vertebral re-ossification
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756086/
https://www.ncbi.nlm.nih.gov/pubmed/26692163
http://dx.doi.org/10.1016/j.ijscr.2015.11.031
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