Systemic Blastomycosis, with Report of a Fatal Case

Abstract

CASES of systemic blastomycosis, though the disease is fairly widespread, are still not very common. In spite of the excellent reviews on the subject and the many cases of systemic blastomycosis which have been reported in the various medical journals, it seems to us that our case, studied from clinical, roentgenologic, bacteriologic, and histopathologic points of view, warrants its publication. At the Rochester General Hospital two cases of systemic blastomycosis have been seen within the last three years. The first one, in which a hen's-egg-sized tumor of the leptomeninges was removed from a 52-year-old white male, was a so-called primary meningeal form and has been reported elsewhere. The tumor showed a great number of budding organisms and a characteristic microscopic picture, however, the case was not entirely conclusive because only histologic examination was done. Cultures could not be prepared and autopsy was not obtained. The second case of systemic blastomycosis with multiple foci was observed during 1930. At the time of the patient's admission only a few lesions were found, nevertheless the correct diagnosis was established in a few weeks, thus determining the available treatment and the poor prognosis. The case is as follows: Case Report C. P., male, Italian parentage, aged 19 years, entered the hospital Feb. 22, 1930, with the following chief complaints: (1) sores on right foot and right wrist, (2) swellings of knees, (3) weakness. The family history was irrelevant. Past History.—The patient was born in, and has always lived in, New York State. He was in the Rochester State Hospital from Sept. 30, 1928, to April 26, 1929, with the diagnosis of dementia præcox, No history of past diseases or symptoms was obtained on searching inquiry. He had been unemployed for some time, though he had previously worked in a grocery store. Most of the history of his present illness was obtained from the family, who had considered the patient physically well until December, 1929. During that month, after a slight trauma, the patient noticed a sore on the right foot, with accompanying fever. The lesion was incised and “pus” obtained; however, drainage of the thin fluid was continuous. The right, and later the left, knee became swollen and painful. Swellings and later ulcerations of the right ankle and right wrist were noted. Fever of varying degrees had been present since the beginning of the illness. Progressive weakness and a loss of ten pounds were experienced. There had been an occasional cough and on one or two occasions a small amount of blood-tinged sputum was expectorated. No gastro-intestinal or genito-urinary symptoms were present. There was no change in the mental state. Physical Examination.—Physical examination revealed that the patient was well developed, but poorly nourished, with an appearance of chronic illness. The skin was yellow, with numerous acneform lesions over the face and chest, and the general hygiene was poor.