Primary cutaneous blastomycosis as a cause of acute respiratory distress syndrom: case report and literature review

Abstract

Blastomycosis is a fungal infection caused by Blastomyces dermatitidis. Exposure in endemic regions frequently occurs when spores in soil are disturbed and subsequently inhaled. Less commonly, primary cutaneous blastomycosis may follow after traumatic inoculation of the fungus into the skin. Most patients infected with blastomycosis are asymptomatic, but an unfortunate small number present with fulminant disease. Rarely, the infection can affect organs, such as the skin, bone, or genitourinary system. In a small percentage of cases, blastomycosis may cause acute respiratory distress syndrome, which is associated with a very high mortality rate. Increased survival rates have been shown when the clinician has a high index of suspicion and facilitates rapid evaluation and initiation of the appropriate therapy. We present a rare case of a patient presenting with primary cutaneous blastomycosis that progressed to disseminated disease causing acute respiratory distress syndrome. High clinical suspicion, prompt diagnostic testing, and therapy with amphotericin B, confirmed the diagnosis and resulted in a swift recovery.

Figure 1

Dark purpleblack eschar over the anterior surface of the right knee

Figure 2

Bilateral pulmonary infiltrates revealed by chest radiograph

Figure 3

Computed tomography of the chest demonstrating bilateral pulmonary infiltrates without any pulmonary embolism

Figure 4a–4c.

Right-knee aspiration stained with methamine silver demonstrating multiple broad-based budding yeast forms