BLASTOMYCOSIS OF THE FOREARM SYNOVIUM IN A CHILD

Blastomyces is a pathogen that may infect healthy and immunocompromise d hosts, Frequently entering the lungs, the initial pneumonitis usuall y is followed by skin and bony involvement secondary to hematogenous s pl ead. Infection of the synovium without bone or skin involvement in the pediatric population has not been reported previously A soft tissu e mass of the forearm in a 9-year-old boy was the initial manifestatio n of blastomycosis. Radiographic images, ultrasound, and magnetic reso nance imaging of the forearm could not distinguish inflammation from s arcoma, Frozen section during open biopsy revealed a granulomatous pro cess and several budding yeasts, There was no evidence of a malignancy Cultures of the tissue grew Blastomyces dermatitidis. The patient was treated successfully with surgical debridement of the mass and amphot ericin B followed by itraconazole, for a total therapeutic course of 1 8 weeks, Although rarely diagnosed in children, blastomycosis must be included in the differential diagnosis of any soft tissue mass.