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Case Reports
. 2025 Mar 8;17(3):e80251.
doi: 10.7759/cureus.80251. eCollection 2025 Mar.

Blasto in the Bronx: An Unusual Case of Severe Cutaneous Blastomycosis in New York City

Sabirah N Kasule  1 , Andrea K Thet  2   1 , Srikaran Bojja  3   4 , Abolfazl Sodagar  5 , Joshua Davidson  5 , Donald D Rudikoff  6 , Lendelle Raymond  7 , Cosmina B Zeana  4
Affiliations
Case Reports

Blasto in the Bronx: An Unusual Case of Severe Cutaneous Blastomycosis in New York City

Sabirah N Kasule et al. Cureus. .

Abstract

Urban cases of blastomycosis are extremely rare and usually involve an individual or individuals with recent travel to, and outdoor exposure in, an endemic area. We report a case of severe cutaneous blastomycosis in a New York City resident. He presented to our hospital in 2023 with multiple cavitary lung nodules and a large area of fungating lesions on his back that had been progressing for a month. Cultures and pathology from the skin lesions confirmed a diagnosis of cutaneous blastomycosis, and the patient was successfully treated with a prolonged course of oral itraconazole. Given no travel history outside of the five boroughs, we believe the patient acquired the infection endemically and is the first published case of blastomycosis acquired in New York City.

Keywords: blastomycosis; cutaneous; fungal; infection; new york city; nyc.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. (a) Lesions at presentation: a 20×20 cm hyperkeratotic and fungating mass with an open abscess cavity on the left side; (b) lesions one month after starting itraconazole; (c) lesions two months after initiating itraconazole; (d) lesions five months after initiating itraconazole.
Figure 2
Figure 2. CT chest from the 2023 admission showing multiple ill-defined nodular infiltrates scattered throughout both lungs, predominantly in the upper lobes. Several nodules exhibit cavitation.
Figure 3
Figure 3. CT chest from 2022 showing a 3 mm left upper lobe nodule (blue arrow) and a 5 mm perifissural right lower lobe nodule (yellow arrow). Not pictured are a 6 mm perifissural right lower lobe nodule and a large left lower lobe consolidation, which were also present.
Figure 4
Figure 4. Skin biopsy with Periodic acid-Schiff (PAS) stain showing thick-walled yeasts with broad-based budding.
See this image and copyright information in PMC

References

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