Disseminated blastomycosis

Abstract

Blastomycosis is a fungal infection caused by Blastomyces dermatitidis, a dimorphic fungus endemic in the soils of the Ohio and Mississippi River Vallys, Great Lakes region, and southeastern United States. It most commonly manifests as a pulmonary infection following inhalation of spores, which causes a broad array of clinical manifestations ranging from asymptomatic infection to fulminant sepsis with acute respiratory distress syndrome and death. Extrapulmonary disease occurs in approximately 25-30% of patients following hematogenous spread from the lungs, with skin being the most common site of exytrapulmonary disease. Here we present a case of disseminated blastomycosis in a healthy 48 year old female.

Keywords: Blastomycosis; Broad-based budding yeast; Itraconazole; Verrucous skin lesions.

Fig. 1

Large verrucous skin lesion over the left thigh.

Fig. 2

Small indurated verrucous skin lesion over the right posterior shoulder.

Fig. 3

Non-contrast CT chest showing : left upper lobe cavitary lung lesion with surrounding consolidation.

Fig. 4

Significant flattening of the cutaneous lesions post six weeks of treatment.

Fig. 5

Follow up non-contrast CT chest showing: significant Interval improvement with decreased size of left upper lobe cavitary lung lesion and near resolution of surrounding consolidation.