The cases of seventy-two patients who had blastomycosis and were seen
between 1926 and 1988 were retrospectively reviewed for involvement of the
musculoskeletal system. Most patients were from rural rather than urban
areas (almost a 2:1 ratio), and an especially large number were from
northwestern Ontario or were native Indians (primarily Ojibwa). Bone was
the second most common site of involvement (seventeen patients); in
approximately one-half of these patients, the osseous site did not cause
symptoms. Metaphyses of long bones and small bones were involved the most;
the metaphyseal lesions tended to be eccentric, well circumscribed, and
lytic. There were two deaths--the most recent, more than twenty years
ago--of patients who had involvement of bones and joints; these patients,
by modern standards, had had inadequate treatment. Treatment with
amphotericin B and, more recently, with ketoconazole, in conjunction with
operative treatment, was very effective.