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• W4387252022 abstract "SESSION TITLE: Beyond the Lungs: Cases of Disseminated Disease SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Blastomycosis is a fungal infection caused by blastomyces species. It predominantly causes an array of pulmonary infections but can spread to the integumentary, musculoskeletal, ophthalmologic, and central nervous systems. We present a case of disseminated blastomycosis in an immunocompetent patient who was diagnosed after developing extensive skin lesions. CASE PRESENTATION: A 40-year-old immunocompetent man from the Ohio River Valley presented to the emergency room for chronic, progressive skin wounds. The patient also reported weight loss, chronic cough with hemoptysis, and fevers. He was evaluated several times for these concerns and was treated unsuccessfully for recurrent pneumonia. In the weeks preceding his illness, he recalled working on the plumbing in the crawlspace underneath his home. The patient eventually sought care from a dermatologist when the wounds began to drain purulent material. Punch biopsies were taken, and he was directed to the emergency room due to concerns for an infectious process. Upon admission, he was hemodynamically stable. Physical examination revealed large, ulcerated wounds with scaling and black eschar formation on erythematous bases present on his scalp, right hand, left foot, and right shin with some satellite lesions. Laboratory evaluation demonstrated neither leukocytosis nor elevated inflammatory markers. Computed tomography imaging of his chest and head demonstrated a left upper lobe consolidation and a left temporal scalp lesion extending deep toward the superolateral orbital wall. A magnetic resonance image of his brain demonstrated no lesions. The biopsy results from his dermatologist were consistent with suppurative granulomatous dermatitis, but PAS and GMS stains were negative for yeast. A repeat biopsy was performed on his scalp lesion, which showed intradermal yeast. A culture obtained from this biopsy grew broad-based budding yeast, later speciated as blastomyces dermatitidis. His blastomycosis antibody also returned elevated. Amphotericin B was administered for ten days, and he was discharged on a course of oral itraconazole. His therapy is currently ongoing; his cough and hemoptysis have resolved, and his cutaneous lesions are healing. DISCUSSION: Blastomycosis is contracted by inhalation of conidia, which develop into yeasts and can spread hematogenously to other organs. Symptoms can develop over a month after initial exposure, which include fevers, chills, productive cough, hemoptysis, weight loss, dyspnea, and chest pain (1). Pulmonary manifestations range from pneumonia of varying chronicity to acute respiratory distress syndrome. As exemplified by this case, patients with chronic blastomycotic pneumonia are often treated for bacterial pneumonia without improvement. Imaging findings typically demonstrate airspace disease, mass-like consolidations, or cavitations with an upper lobe predominance (2). Diagnosis can be delayed until the development of multiorgan dysfunction, and cultures of affected areas carry the greatest sensitivity. In cases of disseminated infection with cutaneous involvement, biopsy with culture of skin lesions can provide a diagnosis. CONCLUSIONS: Blastomycosis should be included in the differential for patients in endemic regions presenting with recurrent pulmonary infections refractory to antibiotics. Their condition can progress to disseminated infection, raising morbidity and mortality. REFERENCE #1: McBride JA, Gauthier GM, Klein BS. Clinical Manifestations and Treatment of Blastomycosis. Clin Chest Med. 2017 Sep;38(3):435-449. REFERENCE #2: Smith JA, Kauffman CA. Blastomycosis. Proc. Am. Thorac. Soc. 2010;7(3):173–80. DISCLOSURES: No relevant relationships by Usama Talib No relevant relationships by Molly Whittaker" @default.
• W4387252022 created "2023-10-03" @default.
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• W4387252022 date "2023-10-01" @default.
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• W4387252022 title "GROWING ON YOU: A CASE OF DISSEMINATED BLASTOMYCOSIS WITH SEVERE CUTANEOUS INVOLVEMENT" @default.
• W4387252022 doi "https://doi.org/10.1016/j.chest.2023.07.822" @default.
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