SHM Converge Scientific Abstract ePoster Gallery-Renovation Gone Wrong: A Hidden Fungal Threat

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A 46-year-old woman presented with left knee pain after exercise. Initial knee MRI suggested a musculoskeletal injury, showing marrow edema, ligament thickening, muscle strain, and effusion. However, her symptoms worsened, and repeat imaging revealed a small lytic tibial lesion with cortical breakthrough and periostitis, raising concern for malignancy such as lymphoma or multiple myeloma.<br /><br />She also developed systemic symptoms, including fatigue, malaise, exertional dyspnea, and hypoxia, with CT chest showing ground-glass opacities. Later, she developed skin lesions. Lab work showed leukocytosis and elevated inflammatory markers. Extensive infectious testing was performed, and all studies were negative except for a positive Blastomyces urine antigen.<br /><br />Her occupational exposure to renovation sites and systemic findings led to the diagnosis of disseminated blastomycosis with osteoarticular, pulmonary, and cutaneous involvement. This case illustrates how blastomycosis can mimic stress fracture, neoplasm, or other infections, particularly when early imaging is nonspecific.<br /><br />Blastomycosis is a systemic fungal infection endemic to the Great Lakes and Mississippi/Ohio River regions. It most commonly spreads to the skin, bones, and genitourinary tract, and bone involvement may present with localized pain and swelling without systemic symptoms. Imaging may show destructive lytic lesions that resemble malignancy.<br /><br />Treatment depends on severity: itraconazole is used for mild to moderate disease, amphotericin B for severe or disseminated disease, and alternative azoles if itraconazole is not tolerated. This case emphasizes the importance of considering fungal infections in patients with compatible exposures, especially in endemic areas, and highlights the need for early diagnosis and treatment.

Asset Subtitle

Adrian P. Umpierrez

Meta Tag

Author List Adrian P. Umpierrez, Rafael Turbay

Category Clinical Vignettes

Concept Blastomycosis

Concept Disseminated Blastomycosis

Concept Lytic Bone Lesions

Concept Osteoarticular Involvement

Concept Itraconazole

Distinguished Non-Finalist

Presenter Organization Emory School of Medicine

Presenting Author Adrian P. Umpierrez

Track Adult

Keywords

blastomycosis

disseminated blastomycosis

tibial lytic lesion

osteomyelitis

ground-glass opacities

cutaneous lesions

pulmonary involvement

lymphoma mimic

fungal infection

itraconazole

Blastomycosis

Disseminated Blastomycosis

Lytic Bone Lesions

Osteoarticular Involvement

Itraconazole