Primary Blastomycosis of Oral Cavity (original) (raw)
Cutaneous Blastomycosis without Evidence of Pulmonary Involvement
Military Medicine, 2003
Blastomycosis is an infection that is often associated with recent military, occupational, or recreational activities near damp soil in various endemic regions, including the Great Lakes and major river valleys in the Midwest as well as various overseas regions. In the great majority of cases, the disease presents as a primary pulmonary disease with or without extrapulmonary involvement. We present a case of cutaneous blastomycosis with no evidence of pulmonary or other systemic involvement. With such presentations, the disease is presumed to have spread hematogenously with the asymptomatic or minimal primary pulmonary infection having resolved spontaneously. The patient's diagnosis was made with positive cultures and histologic examinations revealing features that are quite characteristic of blastomycosis. The patient responded to treatment with itraconazole for 6 months with no recurrence after 1 year. A high index of suspicion must be maintained when evaluating patients with progressive ulcerating or verrucous lesions that do not respond to traditional antibiotic therapy, especially with a history of recent activities in the endemic regions.
Primary Cutaneous Blastomycosis: An Ulcerated Wound in an Immunocompetent Patient
Cureus
The report describes a case of cutaneous blastomycosis. The patient was a healthy elderly male with a history of rectal adenocarcinoma, who presented with an ulcerating wound on his left buttock. Fungal culture was positive for Blastomyces dermatitidis, and the patient was treated with itraconazole followed by voriconazole for three months, which led to clinical resolution of the infection. This highlights an atypical case of blastomycosis, which presented as an isolated skin condition, without pulmonary or hematogenous complications. There are many challenges to diagnosing blastomycosis due to its wide range of symptoms, which can mimic other conditions, making it difficult to diagnose. Accurate diagnosis of blastomycosis is crucial to provide effective treatment and prevent potential complications, such as the infection spreading to other parts of the body and causing systemic symptoms. The report concludes by emphasizing the importance of a high index of suspicion for the diagnosis of cutaneous blastomycosis.
Disseminated Blastomycosis in a Teenager Presenting with Pleural Effusion and Splenomegaly
The Journal of Emergency Medicine, 2019
Background: Blastomycosis is caused by a fungus endemic to states and providences bordering the Lawrence Rivers and the Great Lakes. It can lead to significant pathology in both immunocompetent and immunocompromised hosts. This case report describes disseminated blastomycosis in an otherwise healthy 16-year-old patient. Case Report: A 16-year-old male presented with a chief complaint of flank pain. In the Emergency Department he described additional symptoms of emesis, cough, and weight loss. His vitals were appropriate; however, he had absent lung sounds in the left lower lung field, splenomegaly, a left thigh abscess, and lower-extremity edema. Imaging studies showed a left pleural effusion, mediastinal shift to the right, splenomegaly, a left psoas abscess, and undifferentiated bony involvement of L1 transverse process and the left 12th rib. Abscess cultures grew Blastomyces dermatitides. He was treated with amphotericin B, demonstrated clinical improvement, and was discharged on itraconazole. Why Should an Emergency Physician Be Aware of This?: The case fatality rate of blastomycosis is estimated at between 4.3% and 6.4%. Patients with solid organ transplant and associated immune suppression had a mortality of 33-38%. Given the nonspecific nature of this condition, a high level of suspicion is required for diagnosis, and early diagnosis is essential, as end organ damage in disseminated disease can include high-severity illness, including acute respiratory distress syndrome and central nervous system dysfunction. If any patient presents with symptomatology involving both skin and pulmonary systems, blastomycosis must be entertained as a possible diagnosis. Prompt diagnosis and treatment will significantly improve morbidity and mortality.
Blastomycosis in a young African man presenting with a pleural effusion
Canadian respiratory journal : journal of the Canadian Thoracic Society
Blastomyces dermatitidis is a dimorphic fungus endemic to north-western Ontario, Manitoba and some parts of the United States. The fungus is also endemic to parts of Africa. Pulmonary and extrapulmonary findings of a 24-year-old African man who presented with weight loss, dry cough and chronic pneumonia not resolving with antibiotic treatment are presented. The unusual occurrence of pulmonary blastomycosis associated with skin lesions and a moderate pleural effusion is reported.
50-Year-Old Year-Old Man With Fever and Rhinorrhea
Mayo Clinic Proceedings, 1995
A 50-year-old male factory worker with a 30-pack-year history of tobacco smoking sought medical assistance from a local physician because of a 4-week history of a "flulike" illness, followed by severe watery rhinorrhea, diffuse sinus headaches, and intermittent mild epistaxis. Occasional coughing produced blood-streaked sputum. The local physician recommended terfenadine (a decongestant) and loracarbef (an antibiotic). Two days after beginning that therapy, the patient experienced loss of hearing in his left ear and painful swelling of both ankles. Another antibiotic (clarithromycin) and an analgesic agent (ibuprofen) were added to the treatment regimen, but the symptoms persisted. During this period, the patient noted night sweats and an involuntary weight loss of 5 kg. The patient had no history of exposure to tuberculosis. Important items from the past medical history included motor vehicle accident-induced fracture of the eighth thoracic vertebral body 14 months earlier and resection of a benign testicular cyst 12 months earlier. The patient was referred to our medical center for further evaluation of the persistent symptoms. A review of his medical records confirmed the previously described course. The clinical examination revealed the following pertinent findings: oral temperature of 37.7°C, respiratory rate of 24 breaths/min, conductive hearing loss in the left ear, mildly painful pitting edema of both ankles, mild dullness to percussion in the right upper lung field anteriorly, suggestion of an effusion in the right knee joint, subjective assessment of generalized weakness, and easy fatiguability. The initial laboratory studies showed the following results: hemoglobin, 12.2 g/dL with normocytic, normochromic erythrocyte indices; total leukocyte count, 9.38 X 10 9 jL (neutrophils 6.8 X 10 9 jL, lymphocytes 1.0 X 10 9 jL, monocytes 1.17 x 10 9 jL, eosinophils 0.27 x 10 9 jL , and basophils 0.068 x 10 9 jL); platelet count, 467 X 10 9 jL; and erythrocyte sedimentation rate, 102 mm in 1 hour. Urinalysis revealed 11 to 20 erythrocytes per high-power field and occasional granular casts. The serum creatinine concentration was 1.0 mg/dL, and the electrolytes were within normal limits. A chest roentgenogram was obtained (Fig. 1).
BMC Infectious Diseases, 2022
Background: Blastomycosis is a disease caused by the fungus Blastomyces-a thermally dimorphic fungus that can cause granulomatous and/or purulent infection. We report here a case of chronic blastomycosis infection in a 24-year-old male patient from Saudi Arabia who presented with recurrent skin abscesses associated with deep-seated and multilevel paraspinal (dorsal and lumbar) collections and bilateral empyema with pulmonary involvement and bilateral psoas abscesses. The diagnosis was made after a CT-guided pleural biopsy revealed the characteristic histopathological findings of blastomycosis. The patient underwent several drainage procedures and was successfully treated with a long-term course of oral itraconazole. Conclusions: Chronic blastomycosis may have clinical and radiologic features similar to thoracic tuberculosis or malignant disease. There is no definite clinical symptom of blastomycosis, and thus a high degree of suspicion is required for early diagnosis. This case is a rare form of blastomycosis with chronic multifocal purulent infection and is the second case of blastomycosis reported in Saudi Arabia.