Blastomycosis-Induced Acute Respiratory Distress Syndrome

Maleeha Ajmal,Fahad Aftab Khan Lodhi,Ahmad Basharat,Afifa Aslam,Gul Nawaz

doi:10.7759/cureus.22207

Abstract

Blastomycosis is a systemic mycosis endemic to the Midwestern and South Central United States. Infection is caused by inhaling spores of Blastomyces dermatitidis (B. dermatitidis) that inhabit soil. Acute respiratory distress syndrome (ARDS) is a rare complication of pulmonary blastomycosis with a significantly high mortality rate. We present a case of blastomycosis associated with severe ARDS treated with traditional prone position ventilation (PPV) and neurally adjusted ventilator assist (NAVA) along with antifungal therapy, steroids, and supportive care in a rural setting with no access to extracorporeal membrane oxygenation (ECMO). This case demonstrates that traditional therapies such as prone position ventilation can help patients with blastomycosis-associated ARDS especially in rural settings where advanced therapies such as ECMO are lacking. The use of NAVA in blastomycosis-associated ARDS needs further research.

Highlights

Blastomycosis is a fungal infection caused by inhaling spores of a thermally dimorphic fungus Blastomyces dermatitidis (B. dermatitidis)
We present a case of blastomycosis associated with severe Acute respiratory distress syndrome (ARDS) treated with traditional prone position ventilation (PPV) and neurally adjusted ventilator assist (NAVA) along with antifungal therapy, steroids, and supportive care in a rural setting with no access to extracorporeal membrane oxygenation (ECMO)
This case demonstrates that traditional therapies such as prone position ventilation can help patients with blastomycosis-associated ARDS especially in rural settings where advanced therapies such as ECMO are lacking

Summary

Introduction

Blastomycosis is a fungal infection caused by inhaling spores of a thermally dimorphic fungus Blastomyces dermatitidis (B. dermatitidis). He was diagnosed with community-acquired pneumonia and was started on intravenous ceftriaxone and azithromycin His condition deteriorated over the 48 hours with septic shock and worsening respiratory symptoms, development of bilateral lung opacities on chest radiograph, and severe hypoxemia, all suggestive of ARDS, requiring intubation and mechanical ventilation (Figure 2). Later, he was transferred to our tertiary care facility for a higher level of care. Antibiotics were changed to liposomal amphotericin B (L-AMB), and he was started on continuous renal replacement therapy to treat severe metabolic acidosis and acute kidney injury He was continued on assist mode of mechanical ventilation with ARDS protocol including lung-protective, low-tidal volume ventilation. The patient continued to follow-up with his primary care physician and infectious disease specialist upon discharge

Discussion

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Disclosures

Bradsher RW