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Abstract
Introduction: Mediastinal blastomycosis has been described in multiple case reports, but no review to date has catalogued its various manifestations or response to treatment. Case presentation: An otherwise healthy 18‐year‐old female presented with lymphadenopathy and was found to have a large mediastinal mass concerning for lymphoma. A subsequent biopsy revealed Blastomyces dermatitidis; the patient responded well to therapy with amphotericin B and itraconazole. Similar cases are reviewed and analysed. Conclusion: Mediastinal blastomycosis is a rare but life‐threatening disease manifestation that responds readily to appropriate antifungal therapy.
Highlights
IntroductionMediastinal blastomycosis has been described in multiple case reports, but no review to date has catalogued its various manifestations or response to treatment
Mediastinal blastomycosis has been described in multiple case reports, but no review to date has catalogued its various manifestations or response to treatment.Case presentation: An otherwise healthy 18-year-old female presented with lymphadenopathy and was found to have a large mediastinal mass concerning for lymphoma
We describe our case and the results of a systematic review on extrapulmonary intrathoracic blastomycosis, focusing on mediastinal involvement
Summary
The dimorphic fungus Blastomyces dermatitidis, endemic to the Great Lakes region and the Ohio and Mississippi River valley basins in the USA (Chapman et al, 1997, 2008; Proctor & Davis, 1996; Ronald et al, 2009; Winer-Muram et al, 1992), was first recognized in Chicago in 1901 (Ricketts, 1901). Her review of systems was notable for a mild, non-productive cough and an unintentional 20-pound weight loss during the previous 2 months She denied sick contacts, exposure to tuberculosis, recent travel outside of the Chicago area, history of mononucleosis, contact with animals, insect bites, frequent infections or sexual activity. The patient recovered uneventfully from the procedure and was discharged to home with a 2-week course of intravenous liposomal amphotericin B 3 mg kg every 24 h followed by a plan for at least 1 year of itraconazole 200 mg twice daily with meals At her 1-month outpatient follow-up appointment, her liver function tests remained normal, the lymphadenopathy had resolved and she felt well again
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