Blastomycosis of the lumbar spine: case report and review of the literature, with emphasis on diagnostic laboratory tools and management |
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Authors: | A G Hadjipavlou J T Mader H J W Nauta J T Necessary G Chaljub A Adesokan |
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Institution: | (1) University of Texas Medical Branch, Department of Orthopaedics and Rehabilitation (Division of Spine Surgery), 301 University Boulevard, 6.136 McCullough Building, Galveston, Texas 77555–0792; USA Tel.: +1-409-747 0122; Fax: +1-409-772 2266, US;(2) University of Texas Medical Branch, Marine Biomedical Institute, Galveston, Texas, USA, US;(3) University of Texas Medical Branch, Department of Surgery (Division of Neurosurgery), Galveston, Texas, USA, US;(4) University of Texas Medical Branch, Department of Radiology, Galveston, Texas, USA, US;(5) University of Texas Medical Branch, Department of Pathology, Galveston, Texas, USA, US |
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Abstract: | We report on the conservative and surgical management of a patient with blastomycosis of the lumbar spine, causing severe
and crippling deformity. The diagnosis was made through biopsy. Curative removal, reconstruction and realignment of the spine
were achieved. Imaging modalities were highlighted, with a detailed discussion of the histology and conservative and surgical
management. We emphasize the importance of early, aggressive treatment of blastomycosis to prevent deformity and disability,
and to enable identification of the best management of a destructive lesion with deformity. This case demonstrates that empirical
treatment should not be used in cases of unusual sinus and abscess locations. Specific diagnosis and early treatment are indicated
to prevent dreadful complications and spinal deformity resulting from blastomycosis. Aggressive antifungal therapy can cure
the disease but does not control complications related to deformity. The latter can only be addressed by surgical reconstruction.
We review the literature of surgical treatment, focusing on abscess drainage, bone fusion and posterior instrumentation in
the absence of addressing the deformity component.
Received: 19 November 1997 Revised: 6 February 1998 Accepted: 16 April 1998 |
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Keywords: | Antifungal Blastomycosis Spine Surgery |
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