A Case of Blastomyces dermatitidis Diagnosed Following Travel to Colorado: A Case Report and Review of Literature

Abstract

The dimorphic fungus Blastomyces dermatitidis, is one of the most frequent causes of endemic fungal infections in the United States as well as various other parts of the world. Clinical presentations vary widely, ranging from asymptomatic to disseminated systemic infections. Blastomycosis usually has a predilection for the lungs, but extra pulmonary manifestations are present in 25-40% of cases, involving the skin, bone, genitourinary tract, and CNS. A fungal culture of tissue specimens and fluids is confirmatory. The mainstay of treatment are the azole antifungals, i.e., itraconazole, and for disseminated disease, amphotericin B. We present a case of a young male with pulmonary blastomycosis who presented with a long incubation period. The non-resolving nature of his symptoms prompted further lab and imaging studies, ultimately leading to full and successful recovery.

Keywords: blastomyces dermatitidis; fungal culture; itraconazole; new york city; pneumonia.

Figure 1. Chest X-ray depicting right upper lobe consolidation (posteroanterior view)

Figure 2. Chest X-ray depicting right upper lobe consolidation (lateral view)

Figure 3. CT Scan of the chest with IV contrast depicting air bronchograms and right upper lobe posterior segment mass (axial view)

Figure 4. CT chest with IV contrast showing a lobulated right upper lobe mass (coronal view)

Figure 5. CT chest with IV contrast clearly showing a mass in the right upper lobe posterior segment (axial view)

Figure 6. Bronchoscopy showing right upper lobe erythema, edema and a heterogenous mass in the posterior segment right upper lobe

A: Trachea; B: Left mainstem bronchus; C: Right mainstem bronchus; D: Right upper lobe; E: Bronchus intermedius; F: Right upper lobe lesion; G: Right upper lobe lesion biopsy; H: Right upper lobe lesion biopsy