Primary cutaneous blastomycosis: Report of a case acquired by direct inoculation of a bullous pemphigoid lesion

Abstract

methoprim-sulfamethoxazole, methyldopa, hydrochlorothiazide, terfenadine, and prednisone. Examination revealed a 1.0 X 0.5 em, erythematous, slightly crusted nodule at the site of a previous vesicle (Fig. 1). A biopsy specimen revealed epidermal hyperplasia and a mixed granulomatous infiltrate with microabscesses and epithelioid histiocytes in the dermis (Fig. 2, A). A periodic acid-Schiff stain showed large broad-based budding yeast forms consistent with blastomycosis (Fig. 2, B). A repeat biopsy specimen for culture failed to grow the organisms. However, a fluorescent antibody test of the original biopsy specimen revealed 2+ staining for Blastomyces dermatitidis, confirming the diagnosis of blastomycosis. Enzymelinked immunosorbent assay for blastomycosis revealed a serum titer of I:8. A chest radiograph was normal. There was no history of a dog bite or previous trauma to the area other than the opening of a blister with a needle. The patient's lesion resolved with 4 weeks of ketoconazole therapy (400 mg daily). No signs suggestive of disseminated blastomycosis developed. A repeat chest radiograph was normal, From the Universityof Texas Medical Branch. Reprint requests:Stephen K. Tyring, MD, PhD, Department of Dermatology, University of Texas Medical Brunch, Route G-83, Galveston, TX 77555-0783. JAM ACAD DERMATOL 1994;31 :277-8. Copyright @ 1994 by the American Academy of Dermatology, Inc. 0190-9622$3.00 + 0 16/54/54352 CASE REPORT