Vertebral Blastomycosis with Paravertebral Abscess: Report of Eight Cases and Review of the Literature

Abstract

Bone is the third most frequent site of disease in patients with blastomycosis, and the vertebrae are among the bones affected most often. We describe the clinical features and treatment of eight patients with vertebral blastomycosis and review the literature regarding this disease. All eight patients had destructive vertebral lesions evident on radiographs, and all had clinical or radiographic evidence of a contiguous abscess. The lower thoracic or lumbar regions were affected most often. Fever and skin lesions typical of blastomycosis were variably present. All but one patient had an abnormal chest radiograph. Treatment included long-term antifungal therapy and drainage of large fluid collections. Five of the eight patients were cured of their disease. Of the other 3 patients, 1 is still receiving therapy and is probably cured, 1 died of blastomycosis, and the status of 1 is unknown. In areas of endemicity, blastomycosis should be a diagnostic consideration for any patient with a destructive vertebral lesion.

Clinical and Laboratory Update on Blastomycosis

“…Extension into the soft tissues causes a painful subcutaneous abscess with draining sinuses. Vertebral osteomyelitis due to blastomycosis most often affects the lower thoracic and lumbar regions of the spine although cervical, upper thoracic, and sacral involvement has been reported (90,105). Extension of infection from the spine, causing paravertebral or psoas abscess, is a frequent complication (8,90,121).…”

“…Extension of infection from the spine, causing paravertebral or psoas abscess, is a frequent complication (8,90,121). All 8 patients with vertebral blastomycosis in one report had evidence of contiguous abscesses (105). As these abscesses track through soft tissues, subcutaneous masses can appear at any spinal level, in the flank, or in the thigh when a psoas abscess extends beneath the inguinal ligament.…”

“…Debridement of bone is necessary only when osteomyelitis fails to respond to medical management; this is uncommon. Percutaneous, computed tomography (CT)-guided aspiration of soft tissue abscesses is an effective approach for the management of paraspinal abscess that may complicate vertebral blastomycosis (25,105).…”

Transmission of Tropical and Geographically Restricted Infections during Solid-Organ Transplantation

“…Many patients who have blastomycosis present with cutaneous involvement as well as pulmonary disease. Other common manifestations of disseminated blastomycosis are genitourinary tract infections, septic arthritis, CNS infection, and osteomyelitis (321).…”

Treatment of fungal infections in adult pulmonary and critical care patients

“…Эта терапия высокоэффективна и также назначается при легочном поражении с не менингеальным распространением (сопровождаю щим легочный процесс или изолированным), но продолжительность лечения увеличивается до 12 мес. при поражении костей (класс рекомендаций ВII) [59][60][61][62][63]. Таким образом, терапия пероральным итракона золом на протяжении 6-12 мес.…”