Pediatric Blastomycotic Osteomyelitis of the Hand

Erpelding, Jason M.; Meister, David; Daley, Roger A.

doi:10.1007/s11552-012-9441-1

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…In addition to osteoarticular infection, histoplasmosis, coccidioidomycosis, and blastomycosis can all cause tenosynovitis that may or may not be adjacent to an area of osteomyelitis, with all reported cases localizing to the hand and wrist [101][102][103][104][105]. In fact, synovitis about the wrist, typically flexor tenosynovitis, seems to be the most common musculoskeletal manifestation of histoplasmosis in healthy patients [106].…”

Section: Musculoskeletal Systemmentioning

confidence: 99%

Endemic mycoses in children in North America: a review of radiologic findings

et al. 2023

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Clinically significant endemic mycoses (fungal infections) in the United States (U.S.) include Blastomyces dermatitidis, Histoplasma capsulatum, and Coccidioides immitis/posadasii. While the majority of infections go clinically unnoticed, symptomatic disease can occur in immunocompromised or hospitalized patients, and occasionally in immune-competent individuals. Clinical manifestations vary widely and their diagnosis may require fungal culture, making the rapid diagnosis a challenge. Imaging can be helpful in making a clinical diagnosis prior to laboratory confirmation, as well as assist in characterizing disease extent and severity. In this review, we discuss the three major endemic fungal infections that occur in the U.S., including mycology, epidemiology, clinical presentations, and typical imaging features with an emphasis on the pediatric population.

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Section: Musculoskeletal Systemmentioning

confidence: 99%

Endemic mycoses in children in North America: a review of radiologic findings

et al. 2023

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“…Skin is the second most common site of infection producing painless verrucous lesions or violaceous ulcerated pustules [8]. Bone is the third most common site occurring in 25% of extrapulmonary cases [3,[9][10][11]. Osseous involvement usually occurs on the vertebrae, ribs, facial bones, skull, and long bones.…”

Section: Case Reportmentioning

confidence: 99%

“…Radiographic appearance is variable, but includes focal lytic lesions with or without periosteal reaction and/or local invasion [3]. Occasionally, a diffused form of osteolysis is present and appears as a moth-eaten pattern on the radiograph.…”

Section: Case Reportmentioning

confidence: 99%

“…The only present symptoms were right ring finger pain, swelling, and erythema. A literature review revealed only four other case reports of pediatric osseous blastomycosis of the finger [1][2][3][4]. Osseous blastomycosis without pulmonary symptoms is an unusual presentation which requires a high index of suspicion to make the correct diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Delayed diagnosis of pediatric osseous blastomycosis of the hand: A brief report

Massey¹,

Perry²,

Berken³

et al. 2017

Hand Microsurg

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Background: Distal fingertip amputations with exposed bone is challenging for the surgeon to manage. In order to reconstruct a good sensate pulp with appropriate closure, various flaps are advocated in the literature. Of these, palmar advancement flap, first described by Moberg in 1964, comprises one of the most popular options. Methods: Thirteen patients (11 male, 3 female) with fingertip injuries were operated. Following the elevation of Moberg flap, proposed modifications were carried out. Joint mobility and pulp sensitivity were recorded as well and advancement scores were noted before and after the modification. These scores were assessed statistically. Results: No complications were noted and there was no need for additional surgery. Excellent joint mobility and pulp sensitivity were maintained. This modification showed a statistically significant improvement in the advancement (p<0.05). Conclusions: Moberg flap is a good option for the closure of fingertip defects. Some simple modifications, as described in here, can enhance the advancement while securing the entire advantages of the flap. IntroductionThe hand is a unique part in the body in and plays important and often irreplaceable functions. In the industrialized world, occupational hand injuries need to be healed as soon as possible. Meanwhile, several healing techniques with various options are being applied to hundreds of thousands of patients by experienced practitioners.Unlike other hand injuries, fingertip amputations need additional attention in order to establish a normal pulp sensibility and maximum range of motion, and like others to maintain the upmost level of hand functioning.In 1964, the volar advancement flap was first described by Moberg for the reconstruction of pulp defects of the thumb (1). This flap is a pedicled advancement flap proximally based on an intact skin pedicle including both neurovascular bundles. This technique establishes a successful neurosensation of the pulp with a limited advancement as well. However, a simple modification as described here, and never been reported elsewhere, can enhance additional advancement. Patients and MethodsThe study was performed with informed consents obtained from all participants.Technique Thirteen patients (11 males, 3 females) with fingertip injuries were operated under regional anaesthesia. Palmar advancement flap was raised over the parathenon (1) (Figure 1a). Both neurovascular bundles were included in the flap so that neurosensible coverage is accomplished (Figure 1b). To increase the Hand Microsurgery & ABSTRACTOsseous blastomycosis of small bones of the pediatric hand is rare. A thirteen-year-old male was reported with a missed diagnosis of right ring finger blastomycosis osteomyelitis and six-week delay in treatment. He was treated successfully with surgical debridement and long term itraconazole. Blastomycosis should be considered in any patient with a lytic bone lesion and prompt tissue cultures are crucial to timely and appropriate treatment.

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