Blastomycosis Research Articles

A Rare Case of Cutaneous Blastomycosis of the Eyelid

A Rare Case of Cutaneous Blastomycosis of the Eyelid

An Unusual Case of Blastomycosis Presenting as "Punched Out" Ulcerations

Background: Cutaneous blastomycosis commonly presents as verrucous, hyperkeratotic nodules or plaques. Less commonly, it presents as ulcerations with accompanying scale crusting or verrucous features. Case Report: A healthy 34-year-old incarcerated male with a history of drug abuse presented with several, well-defined (punched out), deep ulcerating cutaneous lesions with undermined borders. There was no crusting, or verrucous features. The clinical differential diagnoses included pyoderma, vasculitic ulcers, and pyoderma gangrenosum. The histopathology from a gluteal ulceration demonstrated pseudoepitheliomatous hyperplasia with acute, chronic, and granulomatous inflammation. PAS stain of the specimen exhibited thick-walled yeast demonstrating broad-based budding typical of blastomycosis and tissue cultures grew Blastomyces dermatitidis after one month. Conclusion: Ulceration without verrucous features can portend cutaneous blastomycosis. Diagnosis using fungal culture of the wound or tissue takes weeks to result. A prompt biopsy and histopathologic examination or broad-range PCR testing of a wound swab, tissue or urine specimen can lead to a prompt diagnosis.

Blastomycosis: An Underrecognized Climate Sensitive Fungal Pathogen Causing Pneumonia in 52-year-old Immunocompetent Women from Southwestern Ohio—A Case Report and Literature Review

Blastomycosis, formerly known as Gilchrist disease, Chicago disease, North American blastomycosis, or Namekagos fever, is an uncommon but underappreciated fungal infection seen mostly in immunocompetent people, caused by the fungi Blastomyces. Blastomyces dermatitidis and Blastomyces gilchristii are the most common species responsible for most infections in the United States of America. Blastomycosis can cause a wide variety of diseases, the most common being pneumonia as the lungs are usually the main primary entrance source of infection after inhalation of Blastomyces spores. However, dissemination from the lungs to other organs such as skin, bones, genitourinary, and central nervous system can occur. We describe a 52-year-old female who was admitted to the hospital for unresolved pneumonia after failure to respond to multiple outpatient antibiotic treatments for a presumed diagnosis of community-acquired pneumonia, presenting with right-sided chest pain, fever, cough and weight loss for three weeks duration. Her initial Chest-X ray and CT chest revealed right middle lobe infiltrate, while her laboratory studies were significant for elevated white blood cells (WBC). The patient underwent diagnostic bronchoscopy which showed erythema of the right middle lobe bronchus with purulent secretion. Furthermore, cytology examination of specimens from bronchoalveolar lavage and bronchial brush from right middle lobe with (PAP) satin on thin prep and H&E stain on the cell block revealed an abundance of broad-base budding yeast consistent with Blastomyces organism, which was confirmed by molecular testing with DNA probe assay. Her serum and urine Blastomyces antigens were positive, above the limit of quantification. The patient was started on antifungal therapy with Amphotericin-B intravenously. In the process, her fever resolved and her respiratory symptoms slowly improved. She was discharged home with oral itraconazole which was to be continued for 6-12 months as an outpatient.

Cutaneous blastomycosis: a case report from the Hassan II University Hospital in Fez

Cutaneous blastomycosis: a case report from the Hassan II University Hospital in Fez

Morphological Diagnosis of Blastomycosis Clinically Presenting as Mycetoma in a Young Immunocompetent Indian Patient; A Diagnostic Dilemma.

Primary cutaneous blastomycosis is very rare in non-endemic regions like India. Only few cases have been reported from India. Herein, we are reporting a rare case of chronic cutaneous blastomycosis in a young immunocompetent male presenting as mycetoma with multiple discharging sinuses in the anterior abdominal wall with no significant travel history.

Man With Thigh Pain

A 33-year-old construction worker with diabetes presented to an emergency department in Chicago, Illinois, with thigh pain for 1 year. Physical examination revealed a large, heme-crusted, multicolored annular plaque with central atrophy and an indurated, verrucous border involving the entire circumference of the lower right thigh (Figure). Laboratory study results were significant for a sedimentation rate of 22 mm/h and a C-reactive protein level of 2.62 mg/dL. A punch biopsy, performed during a dermatology consultation, later confirmed the diagnosis. Cutaneous blastomycosis. Blastomycosis is a systemic pyogranulomatous infection, endemic to states surrounding Mississippi and the Ohio River Valley, that occurs because of inhalation of spores from Blastomyces dermatidis or Blastomyces gilchristii. Immunocompromised patients and those with diabetes are at the highest risk for infection.1Lemos L.B. Baliga M. Guo M. et al.Acute respiratory distress syndrome and blastomycosis: presentation of nine cases and review of the literature.Ann Diagn Pathol. 2001; 5: 1-9Crossref PubMed Scopus (64) Google Scholar,2Pappas P.G. Threlkeld M.G. Bedsole G.D. et al.Blastomycosis in immunocompromised patients.Med (Baltim). 1993; 72: 311-325Crossref PubMed Scopus (149) Google Scholar Although the most common site of infection is the lungs, presenting as pneumonia, hematogenous spread and extrapulmonary manifestations are common.3Azar M.M. Massi R. Relich R.F. et al.Blastomycosis in Indiana: clinical and epidemiologic patterns of disease gleaned from a multicenter retrospective study.Chest. 2015; 148: 1276-1284Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar The skin is the second most common site of infection, mimicking squamous cell carcinoma, with bone being the third, presenting as osteomyelitis.4Oppenheimer M. John M.E. Black B. et al.Blastomycosis of bones and joints.South Med J. 2007; 100: 570-578Crossref PubMed Scopus (51) Google Scholar The final diagnosis is made by histology and culture of infected tissue. Before the advent of effective antifungals, systemic blastomycosis often progressed to acute respiratory distress syndrome with high general mortality.3Azar M.M. Massi R. Relich R.F. et al.Blastomycosis in Indiana: clinical and epidemiologic patterns of disease gleaned from a multicenter retrospective study.Chest. 2015; 148: 1276-1284Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar,5Martin D.S. Smith D. Blastomycosis I: a review of the literature.Am Rev Tuberc. 1939; 39: 275Google Scholar Current treatments include amphotericin B or azole therapy. Lethal cases now most commonly occur in the setting of acute pulmonary blastomycosis and associated acute respiratory distress syndrome.1Lemos L.B. Baliga M. Guo M. et al.Acute respiratory distress syndrome and blastomycosis: presentation of nine cases and review of the literature.Ann Diagn Pathol. 2001; 5: 1-9Crossref PubMed Scopus (64) Google Scholar Our patient biopsy result confirmed pulmonary blastomycosis, likely from an occupational exposure, which improved with systemic itraconazole.

Cutaneous Blastomycosis Presenting as a Nonhealing Wound in the Northeast United States: A Case Report.

Primary cutaneous blastomycosis is a rare presentation of infection caused by direct inoculation of a wound. We present a 61-year-old male with an extensive history of wound dehiscence and wound care noncompliance after a bite from a brown recluse spider on the left thigh while on vacation in Cape Cod in September of 2020. After antibiotic therapy and culture, treatment involved debridement, split thickness skin grafting, strict wound vacuum-assisted closure care, and oral itraconazole. This brief demonstrates a case of blastomycosis arising from trauma in a non-endemic region for infection and serves as an example of successful management of the longstanding wound.

Primary Cutaneous Blastomycosis with Secondary Pulmonary Involvement: A Case Report

Cutaneous blastomycosis is the second most common presentation of Blastomyces Dermatitidis infection. Commonly, skin involvement results from hematogenous spread of infection from a distant site but direct skin involvement can also occur from trauma and animal scratch or bite resulting in cutaneous inoculation blastomycosis. Clinical features of cutaneous blastomycosis are nonspecific and overlap with other fungal and bacterial infections and skin malignancies. A high degree of suspicion is required for diagnosis while evaluating a patient with recurrent skin lesions not responding to antibiotics. In these cases, fungal cultures and histology are of paramount importance for prompt diagnosis and treatment. We present a case of primary cutaneous blastomycosis with secondary lung involvement.

A case of cutaneous blastomycosis

A case of cutaneous blastomycosis

Cutaneous and pulmonary Gilchrist disease : a case report from the Hassan II University Hospital in Fez

Cutaneous and pulmonary Gilchrist disease : a case report from the Hassan II University Hospital in Fez

Pathological and Microbiological Diagnosis of Cutaneous Blastomycosis in a Four Months Old Dog in Zambia

Background: Blastomycosis is usually a systemic fungal disease, most commonly diagnosed in dogs and humans. Cutaneous involvement primarily results from hematogenous spread, but in rare cases, direct inoculation can occur. Case presentation: The current report describes a case of a four-month-old male dog presented with cutaneous lesions caused by Blastomyces dermatitidis without the pulmonary or disseminated disease. Diagnosis was achieved through histopathology and culture. Surgical debulking associated with systemic therapy with oral itraconazole resulted in significant remission of the lesion. Conclusions: To the authors' knowledge, this is the first case of cutaneous blastomycosis reported in an animal in Zambia, which was successfully treated using oral itraconazole. Accurate diagnosis and treatment of the disease in dogs is of public health importance as canine blastomycosis can be a presage of the disease in humans.

Cutaneous blastomycosis as a malodorous wound

Cutaneous blastomycosis as a malodorous wound

Cutaneous Blastomycosis and Systemic Findings

ABSTRACT Blastomycosis is a disease that has the ability to affect nearly any organ system, most commonly causing pulmonary disease. Diagnosis of blastomycosis therefore presents a unique problem for clinicians because of its diverse array of presentations. Cutaneous disease secondary to pulmonary disease may be the initial manifestation of blastomycosis. Cutaneous disease also has variable presentations from pustules to warty verrucous or ulcerated lesions. This article will focus on the cutaneous presentation of blastomycosis, including primary inoculation and secondary disseminated types, as well as other manifestations of blastomycosis in other organ systems. Diagnostic methods and general treatment guidelines will also be discussed.

A Rare Case of Recurrent Blastomycosis in North America

Blastomycosis is a chronic granulomatous and suppurative mycoses caused by Blastomyces dermatitidis. The majority of cases show a primary pulmonary disease. We report a 65-year-old male patient with two painless, violaceous nodules over the left chest wall and right inner thigh. Initially, differential diagnoses of disseminated Blastomycosis, Pneumonia, and Diffuse large B-cell lymphoma made based on past and present clinical history and presentation. The final diag-nosis of disseminated with secondary cutaneous Blastomycosis in a followup case of Diffuse large B-cell lymphoma made based on skin biopsy, broncho-alveolar lavage, and bronchial brushing showing budding yeasts of Blastomyces. The patient responded well to therapy with Amphotericin B and Itraconazole along with intravenous methylprednisolone.

A 25-Year History of Leg Ulceration: Cutaneous Blastomycosis.

A 25-Year History of Leg Ulceration: Cutaneous Blastomycosis.

Pathology of cutaneous blastomycosis in a cat

Cats are common as pet animals in Indonesia and live in close vicinity of human neighborhood, which make them potential for transmitting diseases to human. Blastomycosis is infectious disease caused by Blastomyces spp yeast. Here we describe morphopathology of blastomycosis found in skin of a Persian Cat. Grossly, the lesion were characterized by ulcerated wounds and multiple subcutaneous small nodules (2-5 mm in diameter) in the base of tail. Skin biopsy was made and further processed for histopathology. Microscopically, the lesion consist of epidermal necrosis, dermatitis, with coalescing dermal granulomatous inflammation, characterized by epitheloid and foreign type giant cells infiltrates. Numerous spherical-shaped structures and pseudohyphae which are Periodic Acid Schiff (PAS)-positive consistent with yeast morphology were found within the granulomas; morphology is also consistent with Blastomyces spp yeasts. Conclusively, multiple granulomatous dermatitis with evidence of Blastomyces yeasts is a hallmark of cutaneous blastomycosis. Exposure to Blastomyces spp yeast may possess infection threat to pet owners.

Cutaneous Blastomycosis Simulating Ganglionic Tuberculosis: A Case Report

Abstract: Blastomycosis is a chronic or subacute deep mycosis caused by a dimorphic fungus called Blastomyces dermatitidis, which usually produces pulmonary disease and, to a lesser extent, extrapulmonary forms such as cutaneous, osteoarticular, genitourinary, among others. Case Report: The authors report a case of primary cutaneous blastomycosis in Brazil, with characteristics that mimic ganglion tuberculosis. The diagnosis was confirmed by biopsy and histopathology. Conclusion: Cutaneous blastomycosis is clinically similar to ganglion tuberculosis, thus being an important differential diagnosis. Thus, knowing the characteristics and particularities of the disease, as well as its epidemiology, are important factors in the diagnosis of the disease. Keywords: Cutaneous blastomycosis, Ganglionic tuberculosis, Verrucous lesions.

The Blastomycosis Bluff by Purpureocillium lilacinum

A 73-year-old patient with a history of rheumatoid arthritis and inclusion body myositis on long-term prednisone and azathioprine presented with a 3-month history of tender erythematous nodules on his right lower extremity (Figure 1). A skin biopsy revealed yeast forms with broad-based budding yeast (Figure 2, [arrow]). Initially, a diagnosis of cutaneous blastomycosis was made, and he was initiated on itraconazole. However, (1-3)-β-d-glucan assay was elevated at >500 pg/mL (reference range: <80 pg/mL), and biopsy culture was returned 11 days later growing a violet-colored colony (Figure 3) identified as Purpureocillium lilacinum under microscopy, with phialides with swollen bases and pigmented and rough-walled conidiophore stipes (Figure 4). Review of previous biopsy identified hyphal elements in addition to yeast forms, and he was switched to voriconazole. At 2-month follow-up, he had significant reduction in pain, erythema, and there was healing of open ulcerations.Figure 2Skin biopsy with broad-based budding yeast (arrow) under 400× magnification with Gomori methenamine silver stain.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Fungal colony with a purple hue on Sabouraud dextrose agar.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4Photomicrograph of Scotch tape preparation of fungal culture with lactophenol aniline with polyvinal alcohol stain under 400 x magnification.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Purpureocillium lilacinum is a ubiquitous fungus that can infect immunocompromised patients.1Pastor F.J. Guarro J. Clinical manifestations, treatment and outcome of Paecilomyces lilacinus infections.Clin Microbiol Infect. 2006; 12: 948-960Abstract Full Text Full Text PDF PubMed Scopus (172) Google Scholar Owing to its ability to sporulate in tissues, it can be confused with Blastomyces dermatitidis but is differentiated by the presence of hyphal elements within tissue biopsy, elevated (1-3)-β-d-glucan, and growth on cultures. Purpureocillium lilacinum is also resistant to amphotericin B, fluconazole, and itraconazole: agents often used to treat blastomycosis, highlighting the importance of definitive diagnosis.2Sotello D. Cappel M. Huff T. Meza D. Alvarez S. Libertin C.R. Cutaneous fungal infection in an immunocompromised host.JMM Case Rep. 2017; 4: e005101PubMed Google Scholar This case illustrates the importance of incorporating all available clinical, laboratory, pathological, and microbiological data when approaching infections in immunocompromised hosts.

Successful Treatment of Cutaneous Blastomycosis in a Renal Transplant Patient With BK Virus Infection: A Case Report

This is the first case report from Turkey to describe a renal transplant complicated by subcutaneous blastomycosis and BK infection. The cutaneous lesions were successfully treated with amphotericin B and fluconazole. The presence of BK infection led to graft failure. Infections with uncommonly seen organisms should be kept in mind due to the impaired T-cell immunity in transplantation.

Opportunistic fungal infection in children and management.

An opportunistic mycosis is a fungal agent of low pathogenicity that specifically infects immunocompromised hosts. Advances in transplantation, preterm care, immunosuppressive therapies and intensive care, have lead to the emergence of pediatric patients with serious immunodeficiency who are vulnerable to nonpathogenic fungi. The advent of the use of biologic agents in pediatric disease as well as the advances in care of preterm and immunosuppressed patients opens up a new cohort of patients at risk of opportunistic mycotic infections. Recent cases of cutaneous histioplasmosis as the presenting sign of hyper-IgM syndrome and the case of cutaneous blastomycosis in a patient treated with infliximab underscore the need to have a high clinical suspicion for deep fungal infections in immunosuppressed patients. The current review will focus on the cutaneous manifestations of cutaneous infections by Aspergillus, Blastomyces, histoplasmosis, and mucormycosis. Greater understanding of these diseases and high-quality research in identification and treatment can enhance care of patients in the coming future.