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Intramedullary Blastomycosis in a Child: Case Report

Published online by Cambridge University Press:  16 February 2016

A.M. Parr  and
D. Fewer
A.M. Parr
Affiliation:
Division of Neurosurgery, University of Manitoba, WinnipegMB, Canada
D. Fewer*
Affiliation:
Division of Neurosurgery, University of Manitoba, WinnipegMB, Canada
*
713-39 Parliament St., Toronto, ON M5A4R2,Canada.
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Abstract

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Objective:

To report a case of spinal intramedullary blastomycosis causing myelopathy. This is the first published case of a pediatric patient with intramedullary blastomycosis and compromised function.

Clinical presentation:

An otherwise healthy 13-year-old patient was diagnosed with respiratory North American blastomycosis. She subsequently received a five-month course of itraconazole with presumed resolution of the infection. The patient presented again at 14 years of age with a lumbar myelopathy. Magnetic resonance imaging revealed an intramedullary lesion of 1 cm diameter at the level of T12-L1.

Intervention:

AT12-L1 laminectomy was performed with a gross total resection of the lesion. Pathological examination and microbiological culture of the specimen was consistent with blastomycosis. Postoperatively, the patient was placed on a five week course of amphotericin B. The patient showed substantial improvement in neurological function.

Conclusion:

Blastomycosis can present as an isolated intramedullary lesion causing compromised function. It should be considered in the differential diagnosis of a patient with a myelopathy and previously recognized blastomycosis. The prognosis is good with surgical resection.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 31 , Issue 2 , May 2004 , pp. 282 - 285
Copyright
Copyright © The Canadian Journal of Neurological 2004

References

1.Crampton, TL, Light, RB, Berg, GM, et al. Epidemiology and clinical spectrum of blastomycosis diagnosed at Manitoba hospitals. Clin Infect Dis 2002; 34: 1310–1316.CrossRefGoogle ScholarPubMed
2.Bradsher, RW. Blastomycosis. Clin Infect Dis 1992; 14[Suppl 1]: 82–90.CrossRefGoogle ScholarPubMed
3.Witorch, P, Utz, JP. North American blastomycosis: a study of 40 patients. Medicine 1968; 47: 169–200.CrossRefGoogle Scholar
4.Saccente, M, Abernathy, RS, Pappas, PG, Shah, HR, Bradsher, RW. Vertebral blastomycosis with paravertebral abscess: report of eight cases and review of the literature. Clin Infect Dis 1998; 26: 413–418.CrossRefGoogle ScholarPubMed
5.Hadjipavlou, AG, Mader, JT, Nauta, HJW, et al. Blastomycosis of the lumbar spine: case report and review of the literature, with emphasis on diagnostic laboratory tools and management. Eur Spine J 1998; 7: 416–421.CrossRefGoogle ScholarPubMed
6.Colombo, N, Berry, I, Norman, D. Infections of the spine. In: Manelfe, C, (Ed.) Imaging of the Spine and Spinal Cord. New York: Raven Press, 1992: 489–512.Google Scholar
7.Thomas, GM. Blastomycosis. In: Feigin, RD, Cherry, JD, (Eds.) Textbook of Pediatric Infectious Diseases. Philadelphia: W.B. Saunders Co., 1992: 1898–1906.Google Scholar
8.Hardjasudarma, M, Willis, B, Block-Payne, C, Edwards, R. Pediatric spinal blastomycosis. Neurosurgery 1995; 37: 534–536.CrossRefGoogle ScholarPubMed
9.Lagging, LM, Breland, CM, Kennedy, DL, et al. Delayed treatment of pulmonary blastomycosis causing vertebral osteomyelitis, paraspinal abscess and spinal cord compression. Scand J Infect Dis 1994; 26: 111–115.CrossRefGoogle ScholarPubMed
10.Tuttle, JG, Lichtwardt, HE, Altshuler, CH. Systemic North American blastomycosis: report of a case with small forms of blastomycetes. Am J Clin Pathol 1953; 23: 890–897.CrossRefGoogle ScholarPubMed
11.Gonyea, EF. The spectrum of primary blastomycotic meningitis: a review of central nervous system blastomycosis. Ann Neurol 1978; 3: 26–39.CrossRefGoogle ScholarPubMed
12.Martin, DS, Smith, DT. Blastomycosis. I. A review of the literature. Am Rev Tuberc 1939;39: 275–304.Google Scholar
13.Hardman, JG, Limbird, LE. Goodman and Gilman’s The Pharmacological Basis of Therapeutics, ed 10. New York: McGraw-Hill Professional Publishing, 2001.Google Scholar
14.Chapman, SW. Blastomycosis dermatitides. In: Mandell, GL, Bennett, JE, Dolin, R, (Eds.) Principles and Practice of Infectious Diseases, 5 ed. New York: Churchill Livingston, 2000: 2733–2746.Google Scholar