Blastomycosis: The great pretender can also be an opportunist. Initial clinical diagnosis and underlying diseases in 123 patients

Lemos, Luciano B.; Baliga, Mithra; Guo, Ming

doi:10.1053/adpa.2002.34575

Cited by 99 publications

(73 citation statements)

References 69 publications

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“…1,2 A 20-year review by Lemos showed that in a series of 123 patients diagnosed with blastomycosis, only 31(25%) cases were preceded by immunosuppression (most commonly HIV, prolonged corticosteroid therapy, and chronic renal failure), although an additional 20 patients (16%) presented with diabetes mellitus as a comorbidity. 2 This study found no association between immunosuppression and the presence of disseminated cutaneous or osseous findings.…”

Section: Discussioncontrasting

confidence: 54%

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Atypical Cutaneous Blastomycosis in a Child With Juvenile Idiopathic Arthritis on Infliximab

et al. 2015

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Blastomyces dermatitidis is a dimorphic fungus endemic to much of North America, particularly the soils of the midwestern and southeastern United States. Human infection typically occurs through inhalation of airborne conidia, which can be followed occasionally by dissemination to the skin, bone, genitourinary system, and central nervous system. A hallmark of the pathogen is that it can cause disease in both immunocompetent and immunosuppressed populations. Blastomycosis is rare in pediatric patients, with cutaneous manifestations occurring even less frequently. Here, we report the case of a 9-year-old boy on iatrogenic immunosuppression with infliximab and methotrexate for juvenile idiopathic arthritis who presented with a nonhealing, indurated plaque of his right ear with significant superficial yellow crusting in the absence of constitutional symptoms. After failing a prolonged course of topical and oral antibiotic therapy, biopsy and tissue culture revealed Blastomyces dermatitidis infection. The area cleared after treatment with oral fluconazole and withdrawal of infliximab. To our knowledge, this is the first report of a pediatric patient developing an infection with B dermatitidis after initiation of therapy with a tumor necrosis factor-a inhibitor. This case also highlights an unusual morphology of cutaneous blastomycosis in an iatrogenically immunosuppressed child.

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Section: Discussioncontrasting

confidence: 54%

“…1,2 Cutaneous lesions can develop via primary inoculation with the fungus or dissemination from primary pulmonary disease. Lesion morphology is classically verrucous or ulcerative in nature.…”

mentioning

confidence: 99%

Atypical Cutaneous Blastomycosis in a Child With Juvenile Idiopathic Arthritis on Infliximab

et al. 2015

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“…In one study, diagnosis was delayed for more than 1 month in nearly half of the cases (3). Blastomycosis was correctly suspected in only 20% of patients, resulting in unnecessary surgeries and treatment delays (7). In two-thirds of patients who died of acute respiratory distress syndrome caused by blastomycosis, the diagnosis was either not suspected or considered only after the patient became moribund (10).…”

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confidence: 99%

Antigen Assay with the Potential To Aid in Diagnosis of Blastomycosis

Durkin¹,

Witt²,

LeMonte³

et al. 2004

J Clin Microbiol

217

135

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We report results of an immunoassay for Blastomyces dermatitidis antigenuria. Sensitivity was 92.9%, and specificity was 79.3%. Cross-reactions occurred in 96.3% of patients with histoplasmosis, 100% of patients with paracoccidioidomycosis, 70% of patients with penicilliosis marneffei, 2.9% of patients with cryptococcosis, and 1.1% of patients with aspergillosis. Reproducibility was 96.3%. These findings support a potential role for antigen testing in blastomycosis.Most patients with blastomycosis exhibit progressive illnesses that require antifungal therapy. In one study, diagnosis was delayed for more than 1 month in nearly half of the cases (3). Blastomycosis was correctly suspected in only 20% of patients, resulting in unnecessary surgeries and treatment delays (7). In two-thirds of patients who died of acute respiratory distress syndrome caused by blastomycosis, the diagnosis was either not suspected or considered only after the patient became moribund (10).At the University of Mississippi Medical Center, the first testing method for diagnosis was cytology in 58% of cases, KOH in 28% of cases, and histology in 12% of cases (8). The overall sensitivities were 93% for cytology, 85.1% for histology, 66.4% for culture, and 48.4% for KOH preparation. Pathologists who are less experienced with morphological

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“…However, recent studies have shown that 25% of the patients with blastomycosis have an underlying immunosupressed condition, like malignancy or HIV, whereas 22% of the patients had diabetes mellitus. 9 The majority of patients with blastomycosis present with pulmonary manifestation. 10 If the immune response in the lung fails to contain the infection, lymphohematogenous dissemination occurs, with foci of infection involving any organ system.…”

Section: Discussionmentioning

confidence: 99%

Autochthonous Blastomycosis of the Adrenal: First Case Report from Asia

Kumar

Sreehari

et al. 2014

The American Society of Tropical Medicine and Hygiene

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Abstract. Systemic endemic mycoses, such as blastomycosis, are rare in Asia and have been reported as health risks among travelers who visit or reside in an endemic area. Adrenal involvement is rarely seen in blastomycosis and has never been reported from Asia. We report the first case of blastomycosis with bilateral involvement of the adrenals in a diabetic patient residing in the state of Arunachal Pradesh, India.

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Blastomycosis: The great pretender can also be an opportunist. Initial clinical diagnosis and underlying diseases in 123 patients

Cited by 99 publications

References 69 publications

Atypical Cutaneous Blastomycosis in a Child With Juvenile Idiopathic Arthritis on Infliximab

Atypical Cutaneous Blastomycosis in a Child With Juvenile Idiopathic Arthritis on Infliximab

Antigen Assay with the Potential To Aid in Diagnosis of Blastomycosis

Autochthonous Blastomycosis of the Adrenal: First Case Report from Asia

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