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Case Reports
. 2018 Dec 3;8(4):207-213.
doi: 10.18683/germs.2018.1148. eCollection 2018 Dec.

Mandibular blastomycosis: A case report and review of the literature

Fritzie S Albarillo  1 , Gotam T Varma  2 , Stephen P R MacLeod  3
Affiliations
Case Reports

Mandibular blastomycosis: A case report and review of the literature

Fritzie S Albarillo et al. Germs. .

Abstract

Introduction: Blastomycosis is an endemic mycosis in the United States known to primarily cause pneumonia. However, dissemination to different organs including the musculoskeletal system has been described.

Case report: We report a case of mandibular blastomycosis in a healthy patient with no evidence of lung involvement. A 28 year-old female presented with recurrent right mandibular osteomyelitis despite courses of antibiotics and surgical debridement. She eventually underwent right hemimandibulectomy. Budding yeasts visualized on Gomori Methenamine-Silver (GMS) and Periodic acid-Schiff (PAS) were morphologically consistent with Blastomyces dermatitidis, and intra-operative cultures showed growth of mold identified as B. dermatitidis by DNA probe. She was placed on a prolonged course of itraconazole with clinical improvement. We also reviewed the literature and found 5 cases of similar presentation which we briefly summarized in this present case report.

Conclusion: Blastomycosis should be considered in patients with recurrent or persistent mandibular osteomyelitis even in immunocompetent individuals.

Keywords: Blastomycosis; mandibular blastomycosis.; mandibular osteomyelitis.

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Conflict of interest statement

Conflicts of interest: FA received grant from Hektoen Institute for Medical Research outside the submitted work. TV and SM – none to disclose.

Figures

Figure 1
Figure 1. Maxillofacial CT with contrast; A. Axial view, bone window: Enlarged right masseter and lytic destruction of the right mandibular ramus (black arrow); B. Axial view, soft tissue window: Enlarged right masseter with loculated abscess, adjacent lytic destruction of the mandibular ramus (black arrow); C. Sagittal view, bone window: Lytic destruction of the right mandibular ramus (black arrow).
Figure 2
Figure 2. A. Purulence noted in the submandibular region (black arrow); B. Resected hemi-mandible. Note destruction of the condyle (black arrow).
Figure 3
Figure 3. A. H&E stain, high power showing abundant neutrophils, giant cell reaction, and poorly-formed granulomas (black arrows); B and C. GMS and PAS stains showing yeast forms, some with broad based budding yeasts (black arrows).
See this image and copyright information in PMC

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