Systemic Blastomycosis Diagnosed by Prostate Needle Biopsy

Abstract

A healthy 51-year-old man presented with a 1-month history of lower urinary tract irritative symptoms. Urinalysis was suggestive of infection, and the patient was treated with multiple antibiotics without relief of symptoms. A urological exam demonstrated abnormal induration of the prostate gland. Biopsy of the prostate gland revealed Blastomyces dermatitidis. In areas whereBlastomyces dermatitidis is endemic, clinicians should be aware of the presence of this fungus and possible sites of infection.

Primary Blastomycosis of Oral Cavity

“…In addition, fine needle aspirations can demonstrate the presence of morphologically typical yeast of B. dermatitidis. 7 In the present case, the clinical presentation with isolated chronic ulcerations of the oral mucosa and the pseudoepitheliomatous hyperplasia of the oral epithelium on biopsy were misleading, and the diagnosis of blastomycosis was only established on the operation specimen. The marked pseudoepitheliomatous hyperplasia of the squamous epithelium with features mimicking squamous cell carcinoma is typically described in cutaneous lesions of blastomycosis and is a diagnostic pitfall a pathologist should be aware of.…”

“…Cutaneous (80% of patients) and skeletal involvements (lower limb and axial skeleton are predominant) 4 are the most common extrapulmonary localizations, 5,6 followed by genitourinary tract. 7 Cutaneous and, in particular, mucosal involvement is uncommon. The primary cutaneous form results from direct inoculation of organism into the skin.…”

Prostatic Aspergillosis in a Heart Transplant Recipient: Case Report and Review

“…23 Prostatic involvement is relatively common in Blastomyces dermatitidis infection and it has even been reported in immunocompetent patients. 24 Another uncommon clinical presentation involves prostatic abscesses resulting from focal accumulation of pus within the prostate 25 Prostatic aspergillosis has been identified in 3 transplant recipients, including the patient described in this study, and in 1 heart, 1 kidney and 1 liver recipient. 7,8 IgG hypogammaglobulinemia, functionally distinct humoral and cellular deficits, as well as decreased levels of activated monocytes were documented in the present case before development of invasive Aspergillus infection.…”

Prostatic Blastomycosis: An Infrequent Cause of Granulomatous Prostatitis

“…There are only a few reported cases of blastomycosis of the prostate in the literature to our knowledge (less than 10) [27]: one case presented with localized prostate involvement [28], two cases involved the prostate and epididymis [26,29], two cases involved the prostate and skin [30,31], and a final case of systemic dissemination was initially diagnosed by transrectal prostate biopsy [32].…”