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Spinal blastomycosis: unusual musculoskeletal presentation with literature review

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Abstract

We report a case of a 41-year-old male who presented to our institution with a large groin mass. CT, MRI and PET imaging was performed and was concerning for a soft tissue abscess likely originating in the lumbar spine. Differential considerations included infection, with atypical infections such as tuberculosis strongly considered. Biopsy revealed fungal elements preliminarily reported as consistent with Cryptococcus neoformans but later revealed to be Blastomyces dermatitidis. The patient responded positively following the introduction of appropriate treatment. This case illustrates the imaging similarities between spinal blastomycosis, spinal tuberculosis, and other fungal infections as well as the need for biopsy to differentiate.

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Acknowledgements

Dr. Kristin Atkins of the University of Virginia Department of Pathology helped with the pathology images for this report.

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Authors and Affiliations

  1. Mid-Atlantic Permanente Group (MAPMG), 2102 E. Jefferson St., Rockville, MD, 20852, USA

    Seyed Emamian

  2. Department of Radiology and Medical Imaging, University of Virginia, 1218 Lee Street, Box 800170, Charlottesville, VA, 22908, USA

    Seyed Emamian, Michael G. Fox, Dustin Boatman, Felicia D. Allard & Nicholas C. Nacey

  3. Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA

    Michael G. Fox

  4. Carilion Clinic, Department of Radiology, 2900 Lamb Circle, Christiansburg, VA, 24073, USA

    Dustin Boatman

  5. University of Arkansas Department of Pathology, Little Rock, AR, 72205, USA

    Felicia D. Allard

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  1. Seyed Emamian
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  2. Michael G. Fox
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Correspondence to Michael G. Fox.

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Emamian, S., Fox, M.G., Boatman, D. et al. Spinal blastomycosis: unusual musculoskeletal presentation with literature review. Skeletal Radiol 48, 2021–2027 (2019). https://doi.org/10.1007/s00256-019-03234-9

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  • DOI: https://doi.org/10.1007/s00256-019-03234-9

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