DELAYED TREATMENT OF PULMONARY BLASTOMYCOSIS CAUSING VERTEBRAL OSTEOMYELITIS, PARASPINAL ABSCESS, AND SPINAL-CORD COMPRESSION

A 36-year-old woman with gallbladder disease had an incidental finding of asymptomatic cavitary lung infection with Blastomyces dermatitidis . No treatment was given initially, and 2 months later she presented w ith vertebral osteomyelitis, paraspinal abscess, and spinal cord compr ession due to dissemination of the fungus. The patient recovered follo wing surgical debridement and treatment with 1 g of amphotericin B, fo llowed by itraconazole 400 mg QD for 6 months. In spite of previous re ports of the self limiting nature of primary pulmonary blastomycosis i n the normal host, antifungal therapy may be needed in cases that do n ot resolve spontaneously within a short period of time, or if transien t immunosuppression may be anticipated as may occur following surgery or after acquisition of other infections.