A 38-year-old man from Manitoba with diabetes and hypertension presented to the emergency department with a 5-month history of a progressively painful right shoulder mass. He also reported 3 weeks of fever, dyspnea, cough, night sweats and weight loss. The patient had mildly increased work of breathing and tachycardia, but was normotensive and normoxemic. He had a tender 15 x 15 cm fluctuant mass overlying the right posterior scapula. Chest radiographs showed a diffuse micronodular pattern and extensive lysis of the right scapula (Appendix 1, available at www.cmaj.ca/lookup /doi/10.1503/cmaj.201177/tab-related-content). Further imaging showed a multifocal, lobulated mass causing invasion and destruction of the right scapula, and diffuse bilateral miliary lesions (Figure 1 and Appendix 1). Our differential diagnosis included tuberculosis, viral pneumonitis, disseminated fungal disease and metastatic malignancy. We also suspected blastomycosis, as the patient frequented an endemic area in Northwestern Ontario (Kenora),...
Disseminated blastomycosis causing scapular destruction.
From: CMAJ: Canadian Medical Association Journal(Vol. 193, Issue 21)
Publisher: CMA Impact Inc.
Document Type: Clinical report
Length: 571 words
Lexile Measure: 1780L
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