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

Abstract

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: An Ulcerated Wound in an Immunocompetent Patient

“…Diagnosing blastomycosis can be challenging, as its clinical features can be similar to those of other skin conditions such as pyoderma, cellulitis, and squamous cell carcinoma [ 3 ]. In addition, skin biopsy results may not always yield a definitive diagnosis, as the fungus can be difficult to culture [ 4 ]. Therefore, a high index of suspicion is required in order to make an accurate diagnosis.…”