CTICasesBlastomycosis
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Imaging findings
A 10-year-old girl presented with knee pain. MRI of the knee showed a large joint effusion, a complex collection posterior to the joint, and a destructive lesion in the tibia with cortical rupture and extension into adjacent soft tissues. A chest radiograph, performed for PICC placement, incidentally revealed a mass at the right hilum. CT scan showed a mass-like area of consolidation in the right hilum and centrilobular stuff in the left lower lobe superior segment, with no effusion or lymphadenopathy. Bone lesion and lung mass without growing bacteria in an asymptomatic child.
Key takeaways
Blastomycosis is a fungal infection that can mimic many other conditions, including tumors and bacterial infections. It can cause both bone involvement (osteomyelitis) and pulmonary manifestations (mass-like consolidation, centrilobular nodules). Diagnosis can be challenging as urinary antigens for Histoplasma may be positive due to cross-reactivity, while Blastomyces antibodies may be negative in active disease. Geographic exposure (e.g., endemic areas) is a critical clue.
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