Albarillo Fritzie S, Varma Gotam T, MacLeod Stephen P R
MD, Division of Infectious Diseases, Loyola University Medical Center, 2160 S. 1st Ave., Maywood, IL 60153, USA.
DO, Carle Foundation Hospital, 611 W. Park Street, Urbana, IL 61801, USA.
Germs. 2018 Dec 3;8(4):207-213. doi: 10.18683/germs.2018.1148. eCollection 2018 Dec.
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.
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 and intra-operative cultures showed growth of mold identified as 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.
Blastomycosis should be considered in patients with recurrent or persistent mandibular osteomyelitis even in immunocompetent individuals.
芽生菌病是美国一种地方性真菌病，主要引起肺炎。然而，也有报道称其可播散至包括肌肉骨骼系统在内的不同器官。
我们报告一例健康患者的下颌芽生菌病，无肺部受累证据。一名28岁女性尽管接受了抗生素治疗和手术清创，仍反复出现右下颌骨髓炎。她最终接受了右半下颌骨切除术。在高碘酸-希夫（PAS）染色和Gomori六胺银（GMS）染色中可见的芽生酵母在形态上与之相符，术中培养显示通过DNA探针鉴定为霉菌生长。她接受了长期的伊曲康唑治疗，临床症状有所改善。我们还查阅了文献，发现了5例类似表现的病例，并在本病例报告中进行了简要总结。
即使是免疫功能正常的个体，对于反复或持续性下颌骨髓炎患者也应考虑芽生菌病。
