{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:59:55Z","timestamp":1769727595871,"version":"3.49.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"26","license":[{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,12,23]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>\n                      The authors describe the case of a 35-year-old male who presented with back pain and painful masses on his upper extremities. He had a known sacral lesion identified 1 year prior at an outside facility, suspected to be coccidioidomycosis on biopsy, but the workup was not completed because the patient left against medical advice and was lost to follow-up. Computed tomography (CT) and magnetic resonance imaging revealed lytic destructive lesions involving the calvaria, thoracolumbar spine, and sacrum, concerning for an active and disseminated infection. Sacrum and right-hand biopsies and culture results from both revealed the growth of\n                      <jats:italic>Blastomyces dermatitidis<\/jats:italic>\n                      . With the exception of limitations due to pain, the patient was neurologically afocal and ambulatory. His pain descriptions were biological in nature rather than mechanical. He was not placed on spinal precautions, and surgery was deferred; he was treated medically with inpatient intravenous antifungals and long-term oral therapy after discharge.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The patient\u2019s back pain was resolved at follow-up, and despite extensive lytic destruction demonstrated on CT imaging at initial assessment, he was found to have good bony remodeling at his affected levels, with no neurological deficits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case illustrates the value of physical examination and symptomatology in surgical decision-making for disseminated fungal infections of the spine, even when imaging studies compellingly suggest instability.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE24204\">https:\/\/thejns.org\/doi\/10.3171\/CASE24204<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case24204","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T01:48:46Z","timestamp":1734918526000},"source":"Crossref","is-referenced-by-count":0,"title":["Nonoperative management for disseminated spinal blastomycosis with extensive lytic destruction in a 35-year-old male: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Tyler X.","family":"Giles","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan C.","family":"Bowen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Ziemke","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jared J.","family":"Marks","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"Infect Dis Clin North Am","first-page":"515","article-title":"Blastomycosis","volume":"35","author":"Mazi","year":"2021","unstructured":"Mazi PBRauseo AMSpec A. Blastomycosis. Infect Dis Clin North Am. 2021;35(2):515-530."},{"issue":"4","key":"bib2","series-title":"J Immunol","first-page":"1796","article-title":"The unappreciated intracellular lifestyle of Blastomyces dermatitidis","volume":"194","author":"Sterkel","year":"2015","unstructured":"Sterkel AKMettelman RW\u00fcthrich MKlein BS. The unappreciated intracellular lifestyle of Blastomyces dermatitidis. J Immunol. 2015;194(4):1796-1805."},{"issue":"13","key":"bib3","series-title":"Spine","first-page":"E442","article-title":"Nonsurgical treatment of lumbosacral blastomycosis involving L2-S1: a case report","volume":"33","author":"Mahiquez","year":"2008","unstructured":"Mahiquez MBunton KLCarney GWeinstein MASmall JM. Nonsurgical treatment of lumbosacral blastomycosis involving L2-S1: a case report. Spine. 2008;33(13):E442-E446."},{"issue":"3","key":"bib4","series-title":"Semin Respir Infect","first-page":"219","article-title":"Endemic blastomycosis in Mississippi: epidemiological and clinical studies","volume":"12","author":"Chapman","year":"1997","unstructured":"Chapman SWLin ACHendricks KA, et al. Endemic blastomycosis in Mississippi: epidemiological and clinical studies. Semin Respir Infect. 1997;12(3):219-228."},{"issue":"8","key":"bib5","series-title":"PLoS One","first-page":"e105466","article-title":"Incidence and trends of blastomycosis-associated hospitalizations in the United States","volume":"9","author":"Seitz","year":"2014","unstructured":"Seitz AEYounes NSteiner CAPrevots DR. Incidence and trends of blastomycosis-associated hospitalizations in the United States. PLoS One. 2014;9(8):e105466."},{"issue":"5","key":"bib6","series-title":"Am J Clin Pathol","first-page":"609","article-title":"Blastomycosis of bone: a clinicopathologic study","volume":"142","author":"Jain","year":"2014","unstructured":"Jain RSingh KLamzabi IHarbhajanka AGattuso PReddy VB. Blastomycosis of bone: a clinicopathologic study. Am J Clin Pathol. 2014;142(5):609-616."},{"key":"bib7","article-title":"Data and statistics on blastomycosis","unstructured":"Data and statistics on blastomycosis. Centers for Disease Control and Prevention. Published April 24, 2024. Accessed November 14, 2024. https:\/\/www.cdc.gov\/blastomycosis\/data-research\/statistics\/index.html."},{"issue":"12","key":"bib8","series-title":"Skelet Rad","first-page":"2021","article-title":"Spinal blastomycosis: unusual musculoskeletal presentation with literature review","volume":"48","author":"Emamian","year":"2019","unstructured":"Emamian SFox MGBoatman DAllard FDNacey NC. Spinal blastomycosis: unusual musculoskeletal presentation with literature review. Skelet Rad. 2019;48(12):2021-2027."},{"issue":"12","key":"bib9","series-title":"Spine","first-page":"E719","article-title":"Fungal infections of the spine","volume":"40","author":"Ganesh","year":"2015","unstructured":"Ganesh DGottlieb JChan SMartinez OEismont F. Fungal infections of the spine. Spine. 2015;40(12):E719-E728."},{"issue":"5","key":"bib10","series-title":"Eur Spine J","first-page":"416","article-title":"Blastomycosis of the lumbar spine: case report and review of the literature, with emphasis on diagnostic laboratory tools and management","volume":"7","author":"Hadjipavlou","year":"1998","unstructured":"Hadjipavlou AGMader JTNauta HJNecessary JTChaljub GAdesokan A. Blastomycosis of the lumbar spine: case report and review of the literature, with emphasis on diagnostic laboratory tools and management. Eur Spine J. 1998;7(5):416-421."},{"issue":"8","key":"bib11","series-title":"Eur Spine J","first-page":"1837","article-title":"Failure modes in conservative and surgical management of infectious spondylodiscitis","volume":"22","author":"Valancius","year":"2013","unstructured":"Valancius KHansen ESH\u00f8y KHelmig PNiedermann BB\u00fcnger C. Failure modes in conservative and surgical management of infectious spondylodiscitis. Eur Spine J. 2013;22(8):1837-1844."},{"issue":"12","key":"bib12","series-title":"Clin Infect Dis","first-page":"1801","article-title":"Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America","volume":"46","author":"Chapman","year":"2008","unstructured":"Chapman SWDismukes WEProia LA, et al. Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(12):1801-1812."},{"key":"bib13","series-title":"J Med Case Rep","first-page":"271","article-title":"Anterior cervical corpectomy and fusion for blastomycosis causing destruction of C6 vertebra: a case report","volume":"9","author":"Patel","year":"2015","unstructured":"Patel KRSzczodry MNeckrysh SSiemionow K. Anterior cervical corpectomy and fusion for blastomycosis causing destruction of C6 vertebra: a case report. J Med Case Rep. 2015;9:271."},{"issue":"4","key":"bib14","series-title":"J Bone Joint Surg Am","first-page":"560","article-title":"Fungal infections of the spine. Report of eleven patients with long-term follow-up","volume":"83","author":"Frazier","year":"2001","unstructured":"Frazier DDCampbell DRGarvey TAWiesel SBohlman HHEismont FJ. Fungal infections of the spine. Report of eleven patients with long-term follow-up. J Bone Joint Surg Am. 2001;83(4):560-565."},{"issue":"3","key":"bib15","series-title":"Acta Neurochir (Wien)","first-page":"487","article-title":"Management of spinal infection: a review of the literature","volume":"160","author":"Lener","year":"2018","unstructured":"Lener SHartmann SBarbagallo GMVCerto FThom\u00e9 CTschugg A. Management of spinal infection: a review of the literature. Acta Neurochir (Wien). 2018;160(3):487-496."},{"issue":"2","key":"bib1","series-title":"Infect Dis Clin North Am","first-page":"515","article-title":"Blastomycosis","volume":"35","author":"Mazi","year":"2021","unstructured":"Mazi PBRauseo AMSpec A. Blastomycosis. Infect Dis Clin North Am. 2021;35(2):515-530."},{"issue":"4","key":"bib2","series-title":"J Immunol","first-page":"1796","article-title":"The unappreciated intracellular lifestyle of Blastomyces dermatitidis","volume":"194","author":"Sterkel","year":"2015","unstructured":"Sterkel AKMettelman RW\u00fcthrich MKlein BS. The unappreciated intracellular lifestyle of Blastomyces dermatitidis. J Immunol. 2015;194(4):1796-1805."},{"issue":"13","key":"bib3","series-title":"Spine","first-page":"E442","article-title":"Nonsurgical treatment of lumbosacral blastomycosis involving L2-S1: a case report","volume":"33","author":"Mahiquez","year":"2008","unstructured":"Mahiquez MBunton KLCarney GWeinstein MASmall JM. Nonsurgical treatment of lumbosacral blastomycosis involving L2-S1: a case report. Spine. 2008;33(13):E442-E446."},{"issue":"3","key":"bib4","series-title":"Semin Respir Infect","first-page":"219","article-title":"Endemic blastomycosis in Mississippi: epidemiological and clinical studies","volume":"12","author":"Chapman","year":"1997","unstructured":"Chapman SWLin ACHendricks KA, et al. Endemic blastomycosis in Mississippi: epidemiological and clinical studies. Semin Respir Infect. 1997;12(3):219-228."},{"issue":"8","key":"bib5","series-title":"PLoS One","first-page":"e105466","article-title":"Incidence and trends of blastomycosis-associated hospitalizations in the United States","volume":"9","author":"Seitz","year":"2014","unstructured":"Seitz AEYounes NSteiner CAPrevots DR. Incidence and trends of blastomycosis-associated hospitalizations in the United States. PLoS One. 2014;9(8):e105466."},{"issue":"5","key":"bib6","series-title":"Am J Clin Pathol","first-page":"609","article-title":"Blastomycosis of bone: a clinicopathologic study","volume":"142","author":"Jain","year":"2014","unstructured":"Jain RSingh KLamzabi IHarbhajanka AGattuso PReddy VB. Blastomycosis of bone: a clinicopathologic study. Am J Clin Pathol. 2014;142(5):609-616."},{"key":"bib7","article-title":"Data and statistics on blastomycosis","unstructured":"Data and statistics on blastomycosis. Centers for Disease Control and Prevention. Published April 24, 2024. Accessed November 14, 2024. https:\/\/www.cdc.gov\/blastomycosis\/data-research\/statistics\/index.html."},{"issue":"12","key":"bib8","series-title":"Skelet Rad","first-page":"2021","article-title":"Spinal blastomycosis: unusual musculoskeletal presentation with literature review","volume":"48","author":"Emamian","year":"2019","unstructured":"Emamian SFox MGBoatman DAllard FDNacey NC. Spinal blastomycosis: unusual musculoskeletal presentation with literature review. Skelet Rad. 2019;48(12):2021-2027."},{"issue":"12","key":"bib9","series-title":"Spine","first-page":"E719","article-title":"Fungal infections of the spine","volume":"40","author":"Ganesh","year":"2015","unstructured":"Ganesh DGottlieb JChan SMartinez OEismont F. Fungal infections of the spine. Spine. 2015;40(12):E719-E728."},{"issue":"5","key":"bib10","series-title":"Eur Spine J","first-page":"416","article-title":"Blastomycosis of the lumbar spine: case report and review of the literature, with emphasis on diagnostic laboratory tools and management","volume":"7","author":"Hadjipavlou","year":"1998","unstructured":"Hadjipavlou AGMader JTNauta HJNecessary JTChaljub GAdesokan A. Blastomycosis of the lumbar spine: case report and review of the literature, with emphasis on diagnostic laboratory tools and management. Eur Spine J. 1998;7(5):416-421."},{"issue":"8","key":"bib11","series-title":"Eur Spine J","first-page":"1837","article-title":"Failure modes in conservative and surgical management of infectious spondylodiscitis","volume":"22","author":"Valancius","year":"2013","unstructured":"Valancius KHansen ESH\u00f8y KHelmig PNiedermann BB\u00fcnger C. Failure modes in conservative and surgical management of infectious spondylodiscitis. Eur Spine J. 2013;22(8):1837-1844."},{"issue":"12","key":"bib12","series-title":"Clin Infect Dis","first-page":"1801","article-title":"Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America","volume":"46","author":"Chapman","year":"2008","unstructured":"Chapman SWDismukes WEProia LA, et al. Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(12):1801-1812."},{"key":"bib13","series-title":"J Med Case Rep","first-page":"271","article-title":"Anterior cervical corpectomy and fusion for blastomycosis causing destruction of C6 vertebra: a case report","volume":"9","author":"Patel","year":"2015","unstructured":"Patel KRSzczodry MNeckrysh SSiemionow K. Anterior cervical corpectomy and fusion for blastomycosis causing destruction of C6 vertebra: a case report. J Med Case Rep. 2015;9:271."},{"issue":"4","key":"bib14","series-title":"J Bone Joint Surg Am","first-page":"560","article-title":"Fungal infections of the spine. Report of eleven patients with long-term follow-up","volume":"83","author":"Frazier","year":"2001","unstructured":"Frazier DDCampbell DRGarvey TAWiesel SBohlman HHEismont FJ. Fungal infections of the spine. Report of eleven patients with long-term follow-up. J Bone Joint Surg Am. 2001;83(4):560-565."},{"issue":"3","key":"bib15","series-title":"Acta Neurochir (Wien)","first-page":"487","article-title":"Management of spinal infection: a review of the literature","volume":"160","author":"Lener","year":"2018","unstructured":"Lener SHartmann SBarbagallo GMVCerto FThom\u00e9 CTschugg A. Management of spinal infection: a review of the literature. Acta Neurochir (Wien). 2018;160(3):487-496."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/8\/26\/article-CASE24204.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/8\/26\/article-CASE24204.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/8\/26\/article-CASE24204.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:56:47Z","timestamp":1769687807000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/8\/26\/article-CASE24204.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,23]]},"references-count":30,"journal-issue":{"issue":"26"},"URL":"https:\/\/doi.org\/10.3171\/case24204","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,23]]}}}