Manuscript in process
Daniele Y. Gusland, MD; Andrew Livermore; Jie Nguyen; Alana K. Sterkel; James Conway, MD
Background: Blastomyces dermatitidis is a dimorphic fungus endemic to the United States and Canada. Though both Histoplasma and Blastomyces are found in similar geographic regions, blastomyces is many times more likely to cause dissemination in the immunocompetent host. Disseminated infection frequently involves the bone. However, given the indolent nature of this fungal infection and the prevalence of more common infectious etiologies of osteomyelitis, diagnosis and treatment is often significantly delayed. Case Report: We review two pediatric cases which initially presented with isolated orthopedic symptoms without documented fever or pulmonary complaints, though both had signs of pulmonary infection on imaging. Discussion: These cases demonstrate the importance of a high level of suspicion as well as appropriate diagnostic work-up, including surgical pathology with fungal stains, when evaluating osteomyelitis in patients exposed to a blastomyces-endemic region.