Blastomycotic osteomyelitis of the pelvis: a case report
Blais, R.E.; Cesani, F.; Ali, S.; Calhoun, J.H.; Mader, J.
American Surgeon 63(5): 414-416
1997
ISSN/ISBN: 0003-1348 PMID: 9128229 Document Number: 483451
A case is reported in a 23-year-old man from Texas, USA , who had lived in the Mississippi River valley for most of his life, who presented with an 8-month history of left hip pain radiating to the left buttocks and knee, associated with a draining sinus from the suprapubic area and left perirectal region. Radiography of the pelvis demonstrated lytic changes in the left hemipelvis. Chest X-ray revealed miliary nodules in the lung bases. Computed tomography of the pelvis revealed extensive bony destruction of the left hemipelvis and bilateral pubic rami. Methicillin-resistant Staphylococcus aureus was isolated from the perirectal abscess and antibiotic therapy was started but gave no improvement. During surgical debridement of the left hemipelvis and pubis, a large soft-tissue mass was encountered anterior to the bladder and was debrided along with the necrotic bone. Intraoperative cultures grew Blastomyces dermatitidis. Symptoms resolved after treatment with amphotericin B (total dose 2 g) followed by itraconazole (200 mg/day for 6 months).