Today we presented a case of middle-aged patient presenting with back pain. We discussed MSK reasons of back pain as well as red flags, physical exam. The patient was treated conservatively and came for follow-up a few months later with lytic lesion in his pelvis. We then discussed bone lesions, lytic-blastic spectrum and non-malignant DDx for lytic bone lesions. The patient was ultimately diagnosed with blastomycosis – bone lesions being one of the most common extra-pulmonary manifestations of blastomycosis. More information on the slides bone lesion – 1.17
Take home points:
- Back pain with red flags including cauda equina symptoms, risk of current or prior malignancy, infection, and fracture needs urgent evaluation
- Identifying the region of pain, numbness, and muscle group weakness can help localize nerve root involvement
- Lytic vs blastic = spectrum, not all lytic lesions are cancer
- Bone involvement is a common extra-pulmonary manifestation of blastomycoses
- When your boss tells you to do something, you can only say NO exactly 23 times..