An Unusual Cause of Horner Syndrome
KEY WORDSclinical image hospital medicine infectious disease
Blastomyces dermatitidis is a fungus endemic to the Mississippi and Ohio River valleys. Inhalation causes primary pulmonary infection, often followed by hematogenous spread to extrapulmonary sites, most commonly skin or bone.1 Osteomyelitis usually involves the vertebra, pelvis, and sacrum.1 The classic radiographic finding in osseous blastomycosis is a well-circumscribed osteolytic lesion with fronts of bone resorption surrounded by a periosteal reaction and remodeling.2, 3 Neurologic manifestations of blastomycosis include meningitis and epidural abscess, and occur in less than 5% of patients.4 Treatment typically involves induction therapy with amphotericin B, followed by 6–12 months of itraconazole.5
Drs. Larkin and Gray were the sole contributors to this manuscript. No funding or financial support was received. This work has not been presented at a conference to date.
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Conflict of Interest
The authors declare that they do not have a conflict of interest.