Multiple abscesses and plaques in an immunocompetent patient

Abstract

A 40-year-old immunocompetent man experiencing housing insecurity presented with a two-week history of fluctuant abscesses on the left forehead and supraorbital area that became crusted, scaly plaques, a pink plaque on the right dorsal hand, and a necrotic ulcer on the right great toe, resistant to two weeks of doxycycline. Shave biopsy of a new plaque on the right cheek revealed large, broad-based fungal yeast forms and concomitant right middle lobe consolidating pneumonia suggestive of a rare case of disseminated blastomycosis with fluctuant abscesses. Fungal cultures confirmed infection with blastomycosis, and patient was started on a six-month course of itraconazole.