Case Of Systemic Blastomycosis Research Articles

Blastomycosis Infection in the Setting of Immunosuppression with Concurrent Methotrexate and Adalimumab for Treatment of Psoriasis

Blastomycosis is a dimorphic fungi endemic to the Ohio/Mississippi Rivers and the Great Lakes that can infect immunocompetent and immunosuppressed individuals. Systemic fungal infections, such as histoplasmosis or blastomycosis, have often been reported in patients taking TNF-α inhibitors such as adalimumab. However, blastomycosis is significantly less common than histoplasmosis and no cases have been described in the literature. We report a case of systemic blastomycosis associated with adalimumab and methotrexate use for psoriasis and psoriatic arthritis treatment that required extensive treatment and discontinuation of both medications. To our knowledge, this is the first case of systemic blastomycosis associated with adalimumab and methotrexate treatment for psoriasis to be described in the literature.

Systemic blastomycosis treated with 2-hydroxystilbamidine.

SCHOENBACH and his co-workers first reported the successful treatment of North American blastomycosis with stilbamidine in 1951.1Prior to that time experiences with the toxic effects of stilbamidine had been well documented.* In 1948, Snapper described the effect of 2-hydroxystilbamidine on the course of multiple myeloma. Of particular interest was the lessened toxicity of the 2-hydroxy form of the drug.7Snapper and others,† in later work, confirmed this decreased toxicity and later reported the effectiveness of this form of stilbamidine in the treatment of blastomycosis.10We would like to add another case of systemic blastomycosis with apparent cure following intensive treatment with 2-hydroxystilbamidine. REPORT OF A CASE R. D. M., a 41-year-old white locomotive engineer, was admitted to the dermatologic and medical service at Michael Reese Hospital on April 8, 1953, with a known diagnosis of disseminated blastomycosis. The past history revealed that in 1927 he had

SEVERE GENERALIZED BLASTOMYCETIC DERMATITIS

In May 1894 Gilchrist examined sections in which he first found blastomycetes. In November 1894 Busse 1 reported a case of systemic blastomycosis in which the diagnosis was confirmed by postmortem examination. In 1896 Gilchrist and Stokes 2 reported a case of chronic cutaneous oidium infection. The causative organism was found in pus and in sections of tissue. Inoculations of animals with fresh tissue gave negative results. The cultural characteristics of the organism were described, and in a subsequent report, in 1896, 3 this case was definitely classified as one of cutaneous blastomycosis. Since its recognition many therapeutic agents have been used in the treatment of the disease, and iodides have held a prominent place among these agents. Little attention has been given to the use of intravenous injections of compound solution of iodine U. S. P., as suggested by Ravaut, 4 in the treatment of this and other mycotic

Systemic Blastomycosis, with Report of a Fatal Case

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.

THE EFFECT OF GENTIAN VIOLET ON THE ORGANISM OF BLASTOMYCOTIC INFECTION

The inhibitory effect of gentian violet on gram-positive bacteria,1and the use of this principle in the isolation of pathogenic molds2and in the treatment in selected cases of infections resulting from these organisms, have been emphasized by Churchman and others. More recently it has been shown3that a similar inhibition, both in vivo and in vitro, is elicited against the thrush fungus. The results herewith reported indicate that the selective action of this dye can be extended to include the closely related yeastlike organism of blastomycosis. The strain used in these tests was recently isolated from the pus in a fatal case of systemic blastomycosis. It was strongly gram-positive, and its morphologic and cultural characteristics were similar to those described by other writers. Fortunately, it was possible to retain this organism in the yeast or budding form for several generations, and the tests were made on

A CASE OF SYSTEMIC BLASTOMYCOSIS, WITH BLASTOMYCETES IN THE SPUTUM.

Through the efforts of Drs. James Nevins Hyde and Frank Hugh Montgomery and other observers, cutaneous blastomycosis is now generally recognized as an entity. The number of reported cases of systemic blastomycosis being few, it seems justifiable to report more or less fully new cases as they occur, so that by a study of the entire group it will be possible definitely to place the disorder in its proper position in medicine. There are now on record four cases of systemic blastomycosis, in which the causative organism appears identical. These were recorded by Busse and Buschke, 1 Montgomery and Walker, 2 Ormsby and Miller 3 and Cleary. 4 Three of the cases were in Chicago, and two of these occurred in the practice of Drs. Hyde and Montgomery. Another case which closely conforms, and which by some observers is classed here, was that reported by Ophuls and Moffitt 5 of

A Case of Systemic Blastomycosis, with Multiple Cutaneous and Snbcutaneous Lesions

A Case of Systemic Blastomycosis, with Multiple Cutaneous and Snbcutaneous Lesions

A CLINICAL REPORT OF A CASE OF BLASTOMYCOSIS OF THE SKIN FROM ACCIDENTAL INOCULATION.

The subject of this report is a physician, 28 years of age, who has had unusually good health, with no history of specific or venereal disease or tuberculosis or any tuberculosis in the immediate family. On December 4, at an autopsy on a case of systemic blastomycosis, he accidentally inflicted a very slight skin wound with the point of a needle on the palmar surface of the left index finger, just in the fold at the junction of the proximal and middle phalanges. The wound was insignificant and apparently healed. At the end of about one week a very small pustule appeared at this point. This was opened and a small drop of pus removed. It was not noticed again until after several days, when a small pustule again appeared and a small drop of pus was evacuated, as before. The affected area was very small, about the size of a pin head or less. The minute pustule was covered by a very thin layer, probably only the epidermis.