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Case Reports
. 2023 Apr 10;8(2):24730114231166668.
doi: 10.1177/24730114231166668. eCollection 2023 Apr.

Blastomyces Osteomyelitis of the Calcaneus With Disseminated Multiorgan Involvement

Rachel Zarchy  1   2 , Juhi Patel  1   2 , Ali Rashidi  3 , Winston Burke  2   4 , Feinan Shi  5 , Jonathan Martin  6
Affiliations
Case Reports

Blastomyces Osteomyelitis of the Calcaneus With Disseminated Multiorgan Involvement

Rachel Zarchy et al. Foot Ankle Orthop. .
No abstract available

Keywords: Blastomyces; calcaneus; histoplasma antigen; itraconazole; osteomyelitis; tubo-ovarian abscess.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Figures

Figure 1.
Figure 1.
Initial photographs of the right anterior leg and heel ulcerations. (A) Anterior leg ulceration after sharp debridement of necrotic and fibrotic tissue. (B) Posterior heel and medial ankle ulcerations, weeks after rupture of posterior heel abscess.
Figure 2.
Figure 2.
Nonweightbearing plain radiograph of right ankle. Lateral view showing bulky and sclerotic appearance of the calcaneus with well-demarcated cystic lesion.
Figure 3.
Figure 3.
(A) T2-weighted sagittal image. (B) T1-weighted sagittal image. (C) T2-weighted axial image. (D) T1-weighted axial image. Magnetic resonance imaging scan of the right ankle revealed increased T2 signal in the calcaneus with decreased signal on T1-weighted images, most of which enhances on postcontrast imaging (Figure 3). A focal area measuring approximately 0.7 × 0.5 cm; however, showed no enhancement on postcontrast imaging.
Figure 4.
Figure 4.
(A) Anterior-posterior portable plain radiograph of the chest displaying blunting of the left costophrenic angle. (B) Computed tomography of the chest displaying linear consolidation with air bronchograms and moderate-sized left-sided pleural effusion with borderline bilateral axillary lymphadenopathy.
Figure 5.
Figure 5.
(A) GMS stain of skin and subcutaneous tissue from right upper leg with focal pseudoepitheliomatous hyperplasia, chronic inflammation, and superficial granulomatous inflammation with Langerhans’ giant cells containing thick-walled broad based budding yeasts, morphologically suggestive of blastomycosis. (B) PAS stain of skin and subcutaneous tissue from right upper leg with thick-walled budding yeasts located in multinucleated giant cells. (C) GMS stain of bone fragments from right calcaneus with necrosis, granulation tissue, acute and chronic inflammation, and granulomas with budding yeasts located in osteocytes. GMS, Grocott methenamine silver; PAS, periodic acid–Schiff.
Figure 6.
Figure 6.
Photographs of the anterior leg and heel obtained 4 months postoperation. (A) Anterior leg ulceration epithelialized. (B) Posterior heel ulceration, medial ankle ulceration, and surgical incision all epithelialized.
See this image and copyright information in PMC

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