Intramedullary blastomycosis in a child:
1: Can J Neurol Sci. 2004 May;31(2):282-5.
Intramedullary blastomycosis in a child: case report.
Parr AM, Fewer D.
Division of Neurosurgery, University of Manitoba, Winnipeg, MB,
OBJECTIVE: To report a case of spinal intramedullary
blastomycosis causing myelopathy. CLINICAL PRESENTATION: An
otherwise healthy 13-year-old patient was diagnosed with
respiratory North American blastomycosis. She subsequently
received a five-month course of itraconazole with presumed
resolution of the infection. The patient presented again at 14
years of age with a lumbar myelopathy. Magnetic resonance
imaging revealed an intramedullary lesion of 1 cm diameter at
the level of T12-L1. INTERVENTION: A T12-L1 laminectomy was
performed with a gross total resection of the lesion.
Pathological examination and microbiological culture of the
specimen was consistent with blastomycosis. Postoperatively, the
patient was placed on a five week course of amphotericin B. The
patient showed substantial improvement in neurological function.
CONCLUSION: Blastomycosis can present as an isolated
intramedullary lesion causing compromised function. It should be
considered in the differential diagnosis of a patient with a
myelopathy and previously recognized blastomycosis. The
prognosis is good with surgical resection.