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• W2768346670 abstract "A 23-year-old previously healthy man presented with a slowly progressive, painful lip lesion. He previous snipped a “pimple” on the lower lip with a woodworking blade, and he then developed the current lesion, which expanded over the past 7 months. He denied fever, chills, malaise, weight loss, cough, shortness of breath, or joint pain. He worked in construction and denied recent travel or sick contacts. He did not own any pets. The physical examination revealed a large, heme-crusted, verrucous, erythematous plaque with a rolled, indurated border on the lower vermillion and cutaneous lips (Figure 1). Laboratory workup, including a complete blood cell count, comprehensive metabolic panel, and HIV antibody, was unremarkable. Chest radiography showed no infiltrate. A skin biopsy specimen exhibited rare, broad-based budding yeast forms, and fungal tissue culture grew blastomyces. The findings were consistent with a diagnosis of primary cutaneous blastomycosis. Blastomycosis is a pyogranulomatous infection caused by inhalation or inoculation of Blastomyces conidia (1Smith J.A. Riddell 4th, J. Kauffman C.A. Cutaneous manifestations of endemic mycoses.Curr Infect Dis Rep. 2013; 15: 440-449Crossref PubMed Scopus (38) Google Scholar, 2Wilson J.W. Cawley E.P. Weidman F.D. Gilmer W.S. Primary cutaneous North American blastomycosis.AMA Arch Derm. 1955; 71: 39-45Crossref PubMed Scopus (33) Google Scholar, 3Gray N.A. Baddour L.M. Cutaneous inoculation blastomycosis.Clin Infect Dis. 2002; 34: E44-E49Crossref PubMed Google Scholar, 4Motswaledi H.M. Monyemangene F.M. Maloba B.R. Nemutavhanani D.L. Blastomycosis: a case report and review of the literature.Int J Dermatol. 2012; 51: 1090-1093Crossref PubMed Scopus (19) Google Scholar), which are typically found in soil and animal habitats in states bordering the Great Lakes, the Ohio River basin, and the Mississippi River. Soil exposure is the greatest risk factor and there is no predilection for sex, race, occupation, or season. Primary pulmonary infection is the characteristic presentation, although most patients do not manifest symptoms. Hematogenous dissemination occurs in 20–80% of cases, typically affecting the skin (presenting as crusted, verrucous papulonodules) and less commonly the skeletal system, genitourinary tract, or central nervous system (1Smith J.A. Riddell 4th, J. Kauffman C.A. Cutaneous manifestations of endemic mycoses.Curr Infect Dis Rep. 2013; 15: 440-449Crossref PubMed Scopus (38) Google Scholar, 2Wilson J.W. Cawley E.P. Weidman F.D. Gilmer W.S. Primary cutaneous North American blastomycosis.AMA Arch Derm. 1955; 71: 39-45Crossref PubMed Scopus (33) Google Scholar, 3Gray N.A. Baddour L.M. Cutaneous inoculation blastomycosis.Clin Infect Dis. 2002; 34: E44-E49Crossref PubMed Google Scholar, 4Motswaledi H.M. Monyemangene F.M. Maloba B.R. Nemutavhanani D.L. Blastomycosis: a case report and review of the literature.Int J Dermatol. 2012; 51: 1090-1093Crossref PubMed Scopus (19) Google Scholar). Primary cutaneous blastomycosis, which is caused by direct, traumatic inoculation of the organism, is fairly rare, with fewer than 50 cases described in the literature (2Wilson J.W. Cawley E.P. Weidman F.D. Gilmer W.S. Primary cutaneous North American blastomycosis.AMA Arch Derm. 1955; 71: 39-45Crossref PubMed Scopus (33) Google Scholar, 3Gray N.A. Baddour L.M. Cutaneous inoculation blastomycosis.Clin Infect Dis. 2002; 34: E44-E49Crossref PubMed Google Scholar, 4Motswaledi H.M. Monyemangene F.M. Maloba B.R. Nemutavhanani D.L. Blastomycosis: a case report and review of the literature.Int J Dermatol. 2012; 51: 1090-1093Crossref PubMed Scopus (19) Google Scholar). It is usually observed in laboratory or morgue workers, and less frequently in dog handlers after a bite or scratch (2Wilson J.W. Cawley E.P. Weidman F.D. Gilmer W.S. Primary cutaneous North American blastomycosis.AMA Arch Derm. 1955; 71: 39-45Crossref PubMed Scopus (33) Google Scholar, 3Gray N.A. Baddour L.M. Cutaneous inoculation blastomycosis.Clin Infect Dis. 2002; 34: E44-E49Crossref PubMed Google Scholar, 4Motswaledi H.M. Monyemangene F.M. Maloba B.R. Nemutavhanani D.L. Blastomycosis: a case report and review of the literature.Int J Dermatol. 2012; 51: 1090-1093Crossref PubMed Scopus (19) Google Scholar). Other reported cases of primary cutaneous infection include tree bark trauma, sawhorse-related injury, grain elevator door–related trauma, and lancing of a bullous pemphigoid bulla (2Wilson J.W. Cawley E.P. Weidman F.D. Gilmer W.S. Primary cutaneous North American blastomycosis.AMA Arch Derm. 1955; 71: 39-45Crossref PubMed Scopus (33) Google Scholar, 3Gray N.A. Baddour L.M. Cutaneous inoculation blastomycosis.Clin Infect Dis. 2002; 34: E44-E49Crossref PubMed Google Scholar, 4Motswaledi H.M. Monyemangene F.M. Maloba B.R. Nemutavhanani D.L. Blastomycosis: a case report and review of the literature.Int J Dermatol. 2012; 51: 1090-1093Crossref PubMed Scopus (19) Google Scholar). Our patient’s condition was likely initiated by intentional trauma from a woodworking blade, which has not been previously described as a source of primary cutaneous blastomycosis. A diagnosis of blastomycosis is usually made via visualization of broad-based budding organisms on sputum or tissue culture, or with skin biopsy histopathology (4Motswaledi H.M. Monyemangene F.M. Maloba B.R. Nemutavhanani D.L. Blastomycosis: a case report and review of the literature.Int J Dermatol. 2012; 51: 1090-1093Crossref PubMed Scopus (19) Google Scholar). The incubation period for primary cutaneous disease is about 2 weeks, while disseminated disease has a longer period, between 4 to 6 weeks (4Motswaledi H.M. Monyemangene F.M. Maloba B.R. Nemutavhanani D.L. Blastomycosis: a case report and review of the literature.Int J Dermatol. 2012; 51: 1090-1093Crossref PubMed Scopus (19) Google Scholar). Mild to moderate pulmonary or cutaneous blastomycosis is treated with 6 to 12 months of oral itraconazole therapy. In cases of severe disease or central nervous system involvement, the lipid formulation of amphotericin B should be used (5Chapman S.W. Dismukes W.E. Proia L.A. et al.Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America.Clin Infect Dis. 2008; 46: 1801Crossref PubMed Scopus (441) Google Scholar). Our patient exhibited significant clearance after 2 weeks of itraconazole therapy. He was subsequently lost to follow-up." @default.
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• W2768346670 title "Primary Cutaneous Blastomycosis After Inoculation From A Woodworking Blade" @default.
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