Chronic paronychia, osteomyelitis, and paravertebral abscess in a child with blastomycosis

Blastomycosis is an unusual fungal infection in children. It is often a chr onic infection characterized by granulomatous and suppurative lesions, Clin ical manifestations include either pulmonary findings or disseminated disea se. Disseminated blastomycosis usually begins with a lung infection that sp reads to the skin, bones, and central nervous system. This is a case report of a child with chronic blastomycosis presenting with chronic paronychia, fever, cough, malaise, and back pain. The child underwent surgical drainage of a paravertebral abscess and administration of intravenous amphotericin B. He was discharged in good condition on oral therapy with ketoconazole. T he literature on blastomycosis, with particular emphasis on clinical presen tations and management, is reviewed. When the history and physical examinat ion suggest a chronic granulomatous or disseminated disease, such as tuberc ulosis, the physician must include blastomycosis in the differential. (C) 2 000 Elsevier Science Inc.