Blastomycosis: Case Report of an Isolated Lesion in the Distal Fibula
A. Alex Jahangir, MD, and Robert K. Heck, MD
Dr. Jahangir is Assistant Professor, Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee. He was an orthopedic resident at the time the article was written.
Dr. Heck is Assistant Professor, Department of Orthopaedic Surgery, University of Tennessee–Campbell Clinic, Memphis, Tennessee.
Blastomycosis (Blastomyces dermatitidis) is a fungal infection that occurs primarily in the lungs, but 15% to 60% of patients with systemic blastomycosis have skeletal involvement. Because the symptoms and radiographic appearance of bony lesions are variable, diagnosis and treatment may be delayed if fungal infections are not included in the differential diagnosis for a patient with a lytic bone lesion. We present the case of a man in his late 30s with no local or systemic signs of infection in whom biopsy-curettage of a painful ankle lesion identified budding yeast consistent with North American blastomycosis. After treatment with itraconazole, the patient was symptom-free and had returned to his previous activities without pain or difficulty.