Blastomycosis-like Pyoderma with Good Response to Acitretin

Abstract

Blastomycosis-like pyoderma is a rare, vegetating skin lesion that is an unusual exaggerated tissue reaction possibly to prolonged primary or secondary bacterial infection. We report a case of blastomycosis-like pyoderma in a man with Down syndrome, diabetes mellitus and hypothyroidism who responsed poorly to conventional therapies, including antibiotics and correction of predisposing factors for a long time, but experienced dramatic improvement after 3 months of acitretin treatment.

Deep Fungal Infections, Blastomycosis-Like Pyoderma, and Granulomatous Sexually Transmitted Infections

“…14 The lesions occur in men and women with no clear gender predominance and can be located on the face, scalp, axilla, trunk, or distal extremities. 15,16 Elderly patients are more commonly affected. 17 There is no single cause of BLP.…”

Blastomycosis-Like Pyoderma in a Patient with Syphilis and HIV Resolving with Antibiotic Therapy

“…abscesses may also be present [10]. The differential diagnosis includes blastomycosis and other deep fungal infections, halogenoderma, pemphigus vegetans, tuberculosis verrucosa cutis, pyoderma gangrenosum, mycobacterial infections, giant keratoacanthoma, and squamous cell carcinoma [2,4,[7][8][9][10][11][12]. Our patient had four of the six criteria for BLP established by Su et al In accordance with the pertinent literature, we refrained from preforming fungal serology and blood halogen level testing.…”

“…Multiple treatments modalities with varying results have been reported in the literature, including: curettage, surgical excision, carbon dioxide laser, potassium iodide, permanganate soaks, radiotherapy, disodium chromoglycate, and acitretin [4,8,9]. Effective treatment with systemic retinoids has also been reported [7].…”

“…While blastomycosis can infect both immunocompetent and immunocompromised patients, Blastomycosis-like pyoderma itself rarely occurs outside the setting of immune dysregulation [3]. It has been postulated previously that BLP's pathogenesis includes an exaggerated tissue reaction due to the host's inability to clear a bacterial colonization [3,4].…”

“…Similarly, only two reports tested for halogen toxicity with the majority of papers stating that halogenoderma could be satisfactorily ruled out by a lack of halogen medication or ingestion in the patient's history [4,6].…”