A case of tracheal and pulmonary blastomycosis presenting as asymptomatic pulmonary nodules

Abstract

Blastomyces is an endemic fungal pathogen found in regions of North America. It is endemic in the Ohio and Mississippi river valleys, New York, Wisconsin, Colorado, Texas, Kansas, Nebraska, and other regions of the United States. It is common in Canada, mainly Ontario and Manitoba. Here, we report a case of tracheal and pulmonary blastomycosis. Interestingly, this case presented as an unexpected diagnosis as part of a malignancy workup. To our knowledge, this is only the second case of tracheal blastomycosis reported in the literature.

Keywords: Blastomycosis; Pulmonary nodules; Tracheal blastomycosis.

Fig. 1

Computed Tomography (CT) imaging of the tracheal lesion. CT images of the tracheal lesion are shown serially at (A) initial diagnosis, (B) mid-way through therapy with oral itraconazole, and (C) after completion of therapy.

Fig. 2

Histopathological analysis of tracheal tissue. A. Hematoxylin and eosin stain of tracheal tissue demonstrates a large round thick-walled yeast cell. B and C., Grocott's methenamine silver stain section showing a round broad-based budding yeast.