Burying Hatchets into Endemic Diagnoses: Disseminated Blastomycosis from a Potentially Novel Occupational Exposure

Abstract

Background: Blastomycosis is an endemic fungal disease predominantly observed in the northern regions of North America. It manifests primarily as pulmonary disease but can also involve dissemination to the skin, bones, and genitourinary tract. Detailed Case Description: We describe a case of a patient in Southern California with disseminated blastomycosis following his occupational exposure to decaying wood. The patient was treated with intravenous amphotericin therapy followed by oral itraconazole therapy with full resolution of his symptoms.

Conclusions: The patient's case presentation serves as a reminder regarding Blastomyces infections diagnosed outside of endemic regions and suggests a potential link between blastomycosis and a novel occupational exposure surrounding axe throwing.

Keywords: Blastomyces dermatitidis; axe throwing; blastomycosis; endemic fungi; occupational exposure.

Figure 1

Mass-like lesion present on the hard palate of the patient’s mouth.

Figure 2

CT scan of chest, right upper lobe pleural and subpleural consolidation with erosive changes at the 3rd and 4th ribs and involvement with the chest wall.

Figure 3

CT scan of head, aggressive lytic lesion of the posterior right parietal bone with an associated 6.6 × 2.1 × 7.1 cm soft tissue mass of the posterior scalp.

Figure 4

Fluctuant, non-erythematous mass overlying the left 2nd metacarpophalangeal (MCP) joint.

Figure 5

Left 2nd MCP biopsy, H&E stain demonstrating characteristic broad-based budding seen in Blastomyces infections.