Disseminated Blastomycosis Involving the Pancreas

Abstract

SESSION TITLE: Lung Infections 1 SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Sunday, October 29, 2017 at 10:45 AM - 12:00 PM INTRODUCTION: Presented is a rare case of disseminated blastomycosis involving the pancreas. CASE PRESENTATION: A 67 year-old African-American male with a history of chronic hepatitis C, diabetes mellitus and latent MTB presented with 2-3 months of dry cough, weight loss and anorexia and a new post-auricular superficial skin lesion. Computed Tomography (CT) revealed mass-like consolidations in the right lower lobe and pancreas [Figure 1]. Wet preparation of skin lesion was negative. He underwent bronchoscopy with bronchoalveolar lavage (BAL) of the right lower lobe and ultrasound-guided aspiration of the pancreatic mass. Pathology of pancreatic mass revealed granulomatous inflammation with hyphae. BAL revealed budding fungus consistent with Blastomycoses. Liposomal amphotericin was started and treatment transitioned to itraconazole after 14 days. Follow up CT revealed significant pulmonary improvement and near complete resolution of the pancreatic mass [Figure 2]. DISCUSSION: Blastomycoses is a dimorphic fungi endemic to the Mississippi and Ohio River regions. Clinical manifestations of infection are broad with pulmonary most common. Dissemination is seen in an estimated 20% of cases most commonly involving the lungs and skin; less commonly bone, genitourinary and CNS. Presented is a rare case of disseminated blastomycosis involving the pancreas. Culture provides definitive diagnosis however direct visualization of yeast form on clinical specimens can be helpful. Treatment depends on severity and presence of extra-pulmonary disease. CONCLUSIONS: Pancreatic involvement in disseminated blastomycosis is rare. Reference #1: Chapman SW, Lin AC, Hendricks KA, et al. Endemic blastomycosis in Mississippi: epidemiological and clinical studies. Semin Respir Infect. 1997;12(3):219-28. Reference #2: Chapman SW, Dismukes WE, Proia LA, et al. Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis. 2008; 46(12):1801-12. Reference #3: Smith JA, Gauthier G. New Developments in Blastomycosis. Semin Respir Crit Care Med. 2015;36(5):715-28. DISCLOSURE: The following authors have nothing to disclose: Craig Schuring, Adnan Khan, Matt Rudd, Amik Sodhi, Dipen Kadaria No Product/Research Disclosure Information