SHM Converge Scientific Abstract ePoster Gallery-A Curious Case of Back Pain With Burst Fracture

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This case report describes a rare presentation of disseminated blastomycosis causing an L5 burst fracture in an immunocompetent 38-year-old man with severe low back pain. He initially had back pain after a motor vehicle collision a year earlier that improved, but developed worsening pain over the preceding four weeks. Imaging showed an L5 burst compression fracture. Because the cause was unclear and inflammatory markers were markedly elevated (WBC 16.3, ESR 150, CRP 113), multiple specialties were consulted, including infectious disease, neurosurgery, pain management, radiology, and oncology.<br /><br />Although the fracture was initially considered possibly traumatic or malignant, a CT chest revealed multiple pulmonary micronodules. A biopsy was performed on hospital day 2. When the patient later developed high fevers and rising leukocytosis, pathology reviewed the biopsy urgently and identified fungal organisms consistent with blastomycosis. He was started on itraconazole and improved clinically.<br /><br />The discussion emphasizes that extrapulmonary blastomycosis most commonly affects the skin, genitourinary system, and bones, usually via spread from a pulmonary source. Bone involvement often presents as osteomyelitis of the vertebrae, pelvis, or sacrum, sometimes resembling tuberculosis. However, an L5 burst fracture is not a typical manifestation and is usually associated with major trauma. This case is notable because the burst fracture was ultimately attributed to infection rather than injury.<br /><br />The key lesson is to maintain a broad differential diagnosis for back pain and vertebral fractures, especially when inflammatory markers are high or the presentation is atypical. Bone biopsy can be crucial for diagnosis when imaging and clinical findings are inconclusive.

Asset Subtitle

Alya Ahsan

Meta Tag

Author List Alya Ahsan, Marina Kovacevic, Osama Ahsan, Osasumwen Osayimwen

Category Clinical Vignettes

Concept Disseminated Blastomycosis

Concept Itraconazole

Concept Bone Involvement

Concept Vertebral osteomyelitis

Concept Bone Biopsy

Distinguished Non-Finalist

Presenter Organization Endeavor Health

Presenting Author Alya Ahsan

Track Adult

Keywords

blastomycosis

L5 burst fracture

disseminated infection

vertebral fracture

back pain

bone biopsy

pulmonary micronodules

osteomyelitis

itraconazole

immunocompetent

Disseminated Blastomycosis

Itraconazole

Bone Involvement

Vertebral osteomyelitis

Bone Biopsy