Paracoccidioidomycosis is an endemic mycosis in Brazil, caused by the fungus Paracoccidioides brasiliensis. Isolated bone involvement without pulmonary focus is rare. This report documents the first case of osteomyelitis of the calcaneus in an immunosuppressed patient, in whom bone infection was the only manifestation of the disease, treated with antifungals and S53P4 bioactive glass to fill the “dead space” in the calcaneus. A 22-year-old male, mixed-race, Brazilian, living in a rural area, presented to the orthopedic emergency department. He reported having had a callus in the Achilles tendon region 5 weeks earlier, which had healed, but since then he had intermittent claudication on walking, at times being unable to walk, with worsening of symptoms in the last week. He also reported low-grade fever and sweating. The clinical history did not include respiratory manifestations or disseminated skin lesions. He was hypertensive and on immunosuppressive medication due to a previous kidney transplant. Magnetic resonance imaging revealed an intracalcaneal collection, and surgical treatment with debridement and filling of the bone defect with S53P4 bioactive glass was indicated. Cultures were partially negative, but histopathological examination of the bone fragment showed fungal infection, and Grocott special staining identified Paracoccidioides brasiliensis. The patient was treated with itraconazole 200 mg/day for eight months and returned to his usual activities five months after surgery. One year after surgery, radiographs showed bone formation and active remodeling of the biomaterial, with good consolidation and no signs or symptoms of disease recurrence. This is a rare case of infection by Paracoccidioides brasiliensis involving the calcaneus in an immunosuppressed patient. It highlights the importance of epidemiological assessment for differential diagnosis and a multidisciplinary clinical-orthopedic approach, with accurate diagnosis and functional bone reconstruction using S53P4 bioactive glass in synergy with antifungal therapy tailored to the patient’s comorbidities. This strategy enabled an effective return of the patient to his usual daily and work activities.
Santos et al. (Sun,) studied this question.