case_images: PMC6450135_01
case_images: Plain radiograph of a 9-year-old boy with a painful left thigh swelling of 5-month duration. There is a reduction in the corticomedullary differentiation of the distal diametaphysis of the femur with soft-tissue swelling, preserved fat plane, spiculated periosteal reaction, and cortical erosion
case_images: JRMS-24-19-g001.jpg
case_images: PMC6450135_01_JRMS-24-19-g001.jpg
case_images: F1
case_images: X-ray report showed a reduction in the corticomedullary differentiation of the distal metaphysis of the femur with soft-tissue swelling, preserved fat plane, spiculated periosteal reaction, cortical erosion, and cauterization [Figure 1].
case_images: Computed tomography scan report showed a reduced corticomedullary differentiation in the distal diametaphysis of the femur with a sunray periosteal reaction with cortical erosion and a hypodense avascular soft-tissue mass in the distal femur
case_images: JRMS-24-19-g002.jpg
case_images: PMC6450135_01_JRMS-24-19-g002.jpg
case_images: F2
case_images: Computed tomography (CT) scan report showed a reduced corticomedullary differentiation in the distal metaphysis of the femur with a sunray periosteal reaction with cortical erosion and a hypodense avascular soft-tissue mass in the distal femur [Figure 2].
case_images: This photomicrograph shows numerous multinucleated giant cells containing cytoplasmic round-to-oval fungal bodies. Furthermore, it observes numerous histiocytes with eccentrically located nuclei with cytoplasmic vacuoles containing oval-shaped fungal bodies of Histoplasma duboisii. Similar bodies were also seen in the giant cells and also extracellularly (H and E, x300)
case_images: JRMS-24-19-g003.jpg
case_images: PMC6450135_01_JRMS-24-19-g003.jpg
case_images: F3
case_images: Similar bodies were also seen in the giant cells and also extracellularly [Figure 3].
case_images: The fungal bodies are highlighted in this periodic acid-Schiff-stained section (x600)
case_images: JRMS-24-19-g004.jpg
case_images: PMC6450135_01_JRMS-24-19-g004.jpg
case_images: F4
case_images: The fungal bodies were also identified using periodic acid-Schiff-staining technique [Figure 4].
case_images: Six months after treatment with antifungal drugs
case_images: JRMS-24-19-g005.jpg
case_images: PMC6450135_01_JRMS-24-19-g005.jpg
case_images: F5
case_images: Follow-up in our hospital continued for the next 2 years and included clinical examination of the patient and x-rays of the affected femoral bone [Figure 5].