We report a case of a 28-year-old immunocompetent man with a left foot swelling and pain of 3 weeks' duration. He was initially treated with antibacterial agents for cellulitis. Lack of clinical improvement with concomitant reticulonodular infiltrates on chest x-ray prompted further work up including magnetic resonance imaging, bone biopsy, and bronchoalveolar lavage. Cultures and histopathologic examinations from lung and bone specimens revealed Blastomyces dermatitidis. He was successfully treated with oral itraconazole for 1 year. Osseous blastomycosis can mimic an acute pyogenic infection. A high index of suspicion should be kept in mind for this infection, especially in patients presenting from endemic areas.
From the *Division of Infectious Diseases, Department of Medicine, Wayne State University, Detroit, MI and †Department of Infectious Diseases, Carle Clinic Association, University of Illinois, Urbana-Champaign, IL.
Reprints: Geetha Sivasubramanian, MD, Department of Infectious Diseases, Department of Medicine, Wayne State University, 3990 John R St, 5 Hudson, Detroit, MI 48201. Email: firstname.lastname@example.org.
The authors have no funding or conflicts of interest to disclose.