Case report

Journal of Medical Case Reports

, 6:342

Open Access This content is freely available online to anyone, anywhere at any time.

Osteomyelitis and pyoarthritis resulting from local paracoccidioidomycosis in an immunocompetent patient: a case report

  • Michel Santana MichelanAffiliated withRadiology, Hospital do Servidor Público Estadual (HSPE/IAMSPE)
  • , Eloy de Ávila FernandesAffiliated withFundação Instituto de Diagnóstico por Imagem (FIDI) at the Hospital do Servidor Público Estadual (HSPE/IAMSPE)
  • , Leonardo Furtado FreitasAffiliated withRadiology, Hospital do Servidor Público Estadual (HSPE/IAMSPE) Email author 
  • , Rodrigo Hoeller RibeiroAffiliated withRadiology, Hospital do Servidor Público Estadual (HSPE/IAMSPE)
  • , Marília Magri MilanoAffiliated withPediatrics, Hospital do Servidor Público Estadual (HSPE/IAMSPE)
  • , Soraya Silveira MonteiroAffiliated withRadiology, Hospital do Servidor Público Estadual (HSPE/IAMSPE)Fundação Instituto de Diagnóstico por Imagem (FIDI) at the Hospital do Servidor Público Estadual (HSPE/IAMSPE)

Abstract

Introduction

Paracoccidioidomycosis is a type of mycosis that is endemic to Brazil and is triggered by the fungus Paracoccidioides brasiliensis. Isolated bone involvement in this disease is very rare, especially in children. To the best of our knowledge this report documents the first case of an immunocompetent pediatric patient in which paracoccidioidomycosis of the hip articulation was the sole manifestation of the disease (that is, there were no pulmonary or skin lesions).

Case presentation

An 11-year-old Brazilian Caucasian boy from a rural area was examined in the orthopedic ward of our emergency department. Our patient reported a three-month history of pain in the right hip with intermittent claudication and also complained of recurring episodes of intense pain and an inability to walk, which he had been experiencing for the previous five days. He additionally presented with a fever that had persisted for two days. Our patient’s medical history did not include any clinical respiratory manifestations, skin lesions, history of trauma or immunosuppression risk factors.

Conclusions

This is one of the very few reported cases of isolated articular involvement in osteomyelitis in a pediatric immunocompetent patient. Paracoccidioidomycosis should be considered among the differential diagnoses in such cases, especially in cases of patients who reside in rural areas where the condition is considered to be endemic, in order to administer the proper course of treatment in a timely fashion and improve the chances of a favorable prognosis.

Keywords

Osteomyelitis Paracoccidioidomycosis Children