Sentinel Presentation of Disseminated Blastomyces dermatitidis Infection as Hip Pain in a Young Adult: A Case Report

Missouri Sports Medicine, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO 65212, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 02/2010; 92(2):469-72. DOI: 10.2106/JBJS.I.00212
Source: PubMed
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    • "Skeletal involvement has been described in 6–60% of blastomycosis cases and is generally the result of hematogenous spread (Oppenheimer et al., 2007; Saccente and Woods, 2010; Saiz et al., 2004). Infection can occur in any bone but is most frequently found in the vertebrae, skull, and long bones (Hamann and Marberry, 2010; Oppenheimer et al., 2007; Saccente and Woods, 2010; Saccente et al., 1998; Saiz et al., 2004; Veligandla et al., 2002). Rarely, direct cutaneous inoculation occurs through a penetrating wound or laboratory injury (Saccente and Woods, 2010; Veligandla et al., 2002). "
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    ABSTRACT: Blastomycosis commonly occurs following inhalation of Blastomyces dermatitidis conidia causing a pulmonary infection and can disseminate to extrapulmonary sites. Osseous involvement primarily results from hematogenous spread but in rare cases direct inoculation can occur. We describe a case of osseous blastomycosis without pulmonary or disseminated disease successfully treated with posaconazole.
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    ABSTRACT: BACKGROUND: Metal-on-metal hip resurfacing arthroplasty (MOM HR) has become an established alternative to traditional metal-on-metal total hip arthroplasty (MOM THA) for younger, more active patients. Nevertheless, concerns remain regarding wear and corrosion of the bearing surfaces and the resulting systemic metal ion distribution. QUESTIONS/PURPOSES: We therefore asked whether (1) serum ion concentrations in patients with MOM HR at the time of long-term followup were higher than concentrations in a control population with no hip implants; (2) the ion concentrations in patients with MOM HR were different from those in patients with MOM THA; and (3) sex would influence ion levels with regard to implant type. METHODS: The MOM HR and MOM THA groups consisted of 25 patients (evaluated at a minimum of 96 months) and 16 patients (evaluated at a minimum of 106 months), respectively. Forty-eight healthy donors were recruited for reference values. Cobalt, chromium, nickel, and molybdenum were measured by furnace graphite atomic absorption spectrophotometry. RESULTS: Ion concentrations of cobalt, chromium, and molybdenum in MOM HR were higher than in controls. Chromium and cobalt release were higher in MOM HR than in MOM THA. The sex-based analysis showed the difference was because women had higher concentrations in the MOM HR group than in the MOM THA group, whereas there was no difference between the men in the two groups. CONCLUSIONS: In MOM HR, high metal ion release persists for the long term. Consequently, it is important to implement strict biomonitoring for patients who have received these implants. The sustained high levels of chromium in females within the MOM HR group are concerning and merits strong consideration when choosing implants in this patient group. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Instructions for Authors online for a complete description of level of evidence.
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    ABSTRACT: Blastomycosis is a rare fungal disease that can cause intraarticular infection and joint destruction requiring surgical reconstruction. We describe a patient who presented with destruction of the knee joint of unknown etiology. The patient was initially treated with debridement and spacer placement followed by antifungal therapy after cultures grew blastomycosis. Following adequate treatment of the infection, the patient was taken back to the operating room for reconstruction with a total knee arthroplasty. The patient had a successful outcome with no evidence of infection at two years following surgery. To our knowledge, this case report represents the first documented case in which a blastomycotic infection of a native knee was successfully treated with a two-stage total knee arthroplasty. Copyright © 2015 Elsevier B.V. All rights reserved.
    No preview · Article · Jun 2015 · The Knee