ABSTRACT
Disseminated blastomycosis can be a devastating disease, affecting multiple organ systems, including the musculoskeletal system. Osteomyelitis from disseminated disease can be difficult to eradicate but is particularly important to successfully manage in the load-bearing bones of the lower extremity. We present a staged protocol for salvage of blastomycotic calcaneal osteomyelitis in the presence of disseminated disease.
Subject(s)
Blastomycosis/therapy , Calcaneus/microbiology , Methicillin-Resistant Staphylococcus aureus , Osteomyelitis/therapy , Salvage Therapy , Staphylococcal Infections/therapy , Adult , Antifungal Agents/therapeutic use , Calcaneus/surgery , Humans , Male , Plastic Surgery Procedures , Staphylococcal Infections/microbiologyABSTRACT
A patient with postvascular graft placement presented with bacteremia but no localizing symptoms. Our standard infected graft workup of computed tomography (CT) scan, ultrasound scan, magnetic resonance imaging (MRI) scan, and additional laboratory tests did not localize the infection source. Nuclear medicine had three options including white blood cell (WBC) scan, gallium scan, and the fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT scan. FDG-PET/CT imaging alone demonstrated the location. We present an unusual case of Mycobacterium abscessus in a vascular graft not localized with CT scan, ultrasound scan, or MRI scan and could only be localized with FDG-PET/CT scan.
