Blastomycosis may be a benign and self-limiting infection or a chronic granulomatous
and suppurative mycosis in which the primary infection is initiated in the
lungs with frequent, subsequent dissemination to other body sites, especially
the skin and bone. The disease is most prevalent in males 40-60 years of age
and in children. Blastomycosis may coexist with bronchogenic carcinoma, histoplasmosis,
severe pulmonary disease, or tuberculosis.
| DISEASE ASSOCIATIONS |
CHARACTERIZATION |
| ACUTE RESPIRATORY DISTRESS SYNDROME |
|
|
Acute respiratory distress syndrome and blastomycosis: presentation
of nine cases and review of the literature.
Lemos LB, Baliga M, Guo M.
Department of Pathology, Cytology Service, University of Mississippi
Medical Center, Jackson, MS, USA.
|
Ann Diagn Pathol 2001 Feb;5(1):1-9 Abstract quote
Mississippi has the highest prevalence of blastomycosis in the country.
In 20 years and 5 months there were 123 patients treated for blastomycosis
at the University of Mississippi Medical Center.
Among these, 107 patients had lung involvement and nine patients (8.4%)
developed acute respiratory distress syndrome. Seven of the nine patients
(78%) died of respiratory failure. In six patients, the lungs were the
only organs involved. The three other patients had involvement of other
organs as well. Average survival after the onset of acute respiratory
distress syndrome was 6.9 days (range, 2 to 17 days). Acute respiratory
distress syndrome can be triggered by pulmonary infections caused by
bacterial diseases and other fungi. Massive proliferation of yeasts
in the pulmonary parenchyma is the typical finding of patients with
blastomycosis and acute respiratory distress syndrome.
Underlying diseases that lead to immunodepression were present in
only one patient and probable partial immunodepression was present in
two other patients. Data from 19 other cases reported in the literature
are discussed.
|
| AIDS |
|
|
Blastomycosis in patients with the acquired immunodeficiency syndrome.
Pappas PG, Pottage JC, Powderly WG, Fraser VJ, Stratton CW, McKenzie
S, Tapper ML, Chmel H, Bonebrake FC, Blum R, et al.
University of Alabama, School of Medicine, Birmingham.
|
Ann Intern Med 1992 May 15;116(10):847-53 Abstract quote
OBJECTIVE: To describe the clinical, demographic, radiographic, diagnostic,
and therapeutic aspects of blastomycosis in patients with the acquired
immunodeficiency syndrome (AIDS).
DESIGN: A retrospective survey.
SETTING: Ten university medical centers and community hospitals, six
in geographic areas endemic for Blastomyces dermatitidis, and four outside
the endemic area.
PATIENTS: We identified 15 patients with blastomycosis and positive
serologic test results for human immunodeficiency virus (HIV).
MEASUREMENTS: A diagnosis of blastomycosis was based on a positive
culture (14 patients) or typical histopathologic features (one patient)
for B. dermatitidis in clinical specimens.
RESULTS: Twelve of 15 patients had a previous or concomitant AIDS-defining
illness at the time of diagnosis of blastomycosis, and only one patient
had a CD4 lymphocyte count of greater than 200 cells/mm3. Two patterns
of disease emerged: localized pulmonary involvement (seven patients),
and disseminated or extrapulmonary blastomycosis (eight patients). Central
nervous system involvement was common (40%). Six patients died within
21 days of presentation with blastomycosis, including four patients
with disseminated and two with fulminant pulmonary disease. Among the
nine patients who survived longer than 1 month, all received amphotericin
B as initial antifungal therapy, and most received subsequent therapy
with ketoconazole. Only two of these nine patients died with evidence
of progressive blastomycosis.
CONCLUSIONS: Blastomycosis is a late and frequently fatal infectious
complication in a few patients with AIDS. In these patients, overwhelming
disseminated disease including involvement of the central nervous system
is common, and it is associated with a high early mortality. Initial
therapy with amphotericin B is appropriate in patients with AIDS and
presumptive blastomycosis.
|
| PREGNANCY |
|
|
Blastomycosis and pregnancy.
Lemos LB, Soofi M, Amir E.
Department of Pathology, University of Mississippi Medical Center,
Jackson, MS; and the Department of Pathology, University of Texas at
Houston.
|
Ann Diagn Pathol 2002 Aug;6(4):211-5 Abstract quote
Blastomycosis is an exceedingly uncommon complication of pregnancy,
rarely encountered by the practicing obstetrician.
However, recognizing its presence during pregnancy and expeditiously
initiating appropriate therapy is of critical importance to the mother
and fetus. Mississippi has the highest prevalence of blastomycosis in
North America. Nevertheless, there have been only three pregnancies
complicated by this fungal disease at the University of Mississippi
Medical Center (Jackson, MS) during two decades. During the same time
frame there were another 120 blastomycotic patients treated at the University
of Mississippi Medical Center. As a condition of partial immunodepression,
a nonobligatory opportunistic fungal disease like blastomycosis can
complicate pregnancy.
From data on our three patients and 16 other published cases, it seems
that fetal risk exceeds maternal risk. There were a total of 20 babies
born from mothers with blastomycosis. Only two babies (10%) had transplacental
infection and both succumbed to blastomycosis. None of the 18 affected
mothers for whom data was available died of the disease. Furthermore,
there was never progression in the mothers, with 14 complete cures and
considerable postpartum regressions of lesions in the other four women.
Even the three women who received no treatment had either noticeable
improvement or total regression of the disease after delivery. One of
the two stillborns with blastomycosis was born to an untreated mother.
|
| LABORATORY/RADIOLOGIC/OTHER TESTS |
CHARACTERIZATION |
| RADIOLOGY |
|
|
Pulmonary blastomycosis: radiologic manifestations.
Halvorsen RA, Duncan JD, Merten DF, Gallis HA, Putman CE.
|
Radiology 1984 Jan;150(1):1-5 Abstract quote
Blastomycosis, an airborne fungal disease with the lung the portal
of entry, is endemic to the central and south central areas of the United
States.
The disease occurs in patients who range from asymptomatic to those
with symptoms of acute pneumonia. Retrospective review of 27 cases from
our institution revealed four well-defined radiographic patterns including
air-space disease, nodular masses, interstitial disease, and cavitation.
Some patients with air-space disease have symptoms of an acute pneumonia;
more commonly they have no pulmonary symptoms. Air-space disease was
the most frequent radiographic pattern in chronic blastomycosis with
proved nonpulmonary disease; therefore, it cannot be regarded as indicative
of early or acute blastomycosis. There was no relationship between the
radiographic pattern and distribution, pulmonary symptomatology, or
clinical stage of the disease.
Our material does not support the previously suggested association
of lower lobe air-space disease with early disease and upper lobe involvement
with the chronic and often disseminated form. A more precise understanding
of the variety of radiographic patterns and the spectrum of clinical
presentations will facilitate diagnosis of pulmonary blastomycosis.
|
| LABORATORY |
|
| GENERAL |
|
|
Pulmonary blastomycosis: an appraisal of diagnostic techniques.
Martynowicz MA, Prakash UB.
Division of Pulmonary and Critical Care Medicine, Department of
Internal Medicine, Mayo Medical School and Mayo Medical Center, Rochester,
MN 55905-0001, USA.
|
Chest 2002 Mar;121(3):768-73 Abstract quote
OBJECTIVES: Pulmonary blastomycosis often mimics bacterial pneumonia
or bronchogenic carcinoma, which may result in delayed therapy or the
performance of unnecessary diagnostic procedures. We have reviewed the
utilization of diagnostic techniques in the workup of patients with
pulmonary blastomycosis, defined their diagnostic yields, and proposed
an optimal diagnostic approach for the patient in whom pulmonary blastomycosis
is considered.
DESIGN: Retrospective chart review of all patients with the diagnosis
of blastomycosis at a major academic medical center.
RESULTS: Of the 119 patients with blastomycosis, 56 (47%) had pulmonary
involvement. A total of 92 specimens were obtained by noninvasive means
(sputa, 72 specimens; tracheal secretions, 5 specimens; and gastric
washings, 15 specimens) in 35 patients. KOH smears were prepared from
22 of those specimens (24%). The diagnostic yield from these culture
specimens obtained by noninvasive means was 86% per patient, and 75%
per single sample. The diagnostic yields from KOH smears were 46% and
36%, respectively. Flexible bronchoscopy was performed in 24 patients
and yielded a diagnosis in 22 (92%). Cultures of bronchial secretions
(19 patients) and BAL fluid (6 patients) were positive in 100% and 67%
of patients, respectively. The corresponding yields of KOH preparations
were 17% (1 of 6 preparations) and 50% (3 of 6 preparations), respectively.
Pathology specimens including those from bronchoscopic lung biopsies
(nine patients), bronchial brushings (two patients), and bronchoscopic
needle aspiration (one patient) were positive in 22%, 50%, and 0% of
cases, respectively. Cytology was usually performed to exclude malignancy
and was positive for Blastomyces dermatitidis in five patients (sputum,
three patients; bronchial washings, two patients). Thoracotomy was performed
in 11 cases, and in all patients the procedure yielded a diagnosis.
Serology results were available in 25 patients. Immunodiffusion was
positive in 10 patients (40%), and complement fixation in 4 patients
(16%).
CONCLUSIONS: In patients with pulmonary blastomycosis, the positive
yield from respiratory specimen cultures is high, but the confirmation
of a diagnosis may take up to 5 weeks. Wet smears and cytology examinations
of respiratory specimens provide quicker diagnoses but are underutilized.
Their routine use is recommended in endemic areas. Commonly used serologic
assays are insensitive and are not useful for diagnostic screening.
|
|
Culture
|
Sabouraud glucose agar, brain heart infusion agar, yeast-extract-phosphate
agar, and a medium with cycloheximide, and then incubate at 30C
Grows best on the yeast extract agar or agar containing yeast extract
such as Mould Inhibitory Agar (IMA)
Mould form to yeast form conversion is necessary to ensure that the
fungus suspected to be B. dermatitidis is not a similar fungus-accomplished
by inoculating Kelley's agar or blood agar supplemented with glutamine
and then incubating the inoculated tubes at 37C
|
|
Exoantigen technique and a DNA culture confirmation
kit
|
|
| SEROLOGY |
|
|
Significance of false-positive serologic tests for histoplasmosis and
blastomycosis in an endemic area.
Jordan MM, Chawla J, Owens MW, George RB.
Department of Medicine, Louisiana State University School of Medicine,
Shreveport 71130.
|
Am Rev Respir Dis 1990 Jun;141(6):1487-90 Abstract quote
False-positive serologic tests for histoplasmosis (H) and blastomycosis
(B) are common in populations from endemic areas. In order to determine
the significance of false-positive test results, we reviewed the final
diagnoses of all patients whose sera were submitted to our laboratory
for radioimmunoassay (RIA) and immunodiffusion (ID) during a 3-yr period.
Of the 263 patients whose sera were examined, 29 (11%) had H or B;
41 (17.5%) of the remaining 234 patients had false-positive test results.
Of these 41 patients, 31 were positive for H alone, and 10 had antibodies
to both H and B. All three patients with false-positive ID tests for
histoplasmosis also had positive titers (greater than or equal to 1:16)
on RIA. No patient had a false-positive ID result for blastomycosis.
The percentage of patients in each of five major diagnostic categories
with and without false-positive serologic tests was similar (p greater
than 0.05). The majority of patients had pulmonary infections, almost
half of which were granulomatous infections other than H or B; this
reflects the clinical indications for requesting fungal serologic tests.
A positive fungal serology is not useful in suggesting the presence
of a pulmonary disease other than H or B in patients from an endemic
area suspected of having a pulmonary mycosis.
|
| GROSS APPEARANCE/CLINICAL VARIANTS |
CHARACTERIZATION |
| General |
|
|
Blastomycosis: organ involvement and etiologic diagnosis. A review of
123 patients from Mississippi.
Lemos LB, Guo M, Baliga M.
Cytopathology Service, Pathology Department, University of Mississippi
Medical Center, Jackson, MS, USA. |
Ann Diagn Pathol 2000 Dec;4(6):391-406 Abstract quote
Blastomycosis can only be diagnosed through the identification of the
yeasts of Blastomyces dermatitidis in body fluids, tissues, or cultured
material.
The charts from 123 patients treated for blastomycosis at the University
of Mississippi Medical Center from January 1980 through May 2000 were
reviewed to determine the role of wet preparation, cytology, histology,
and culture in diagnosing this fungal disease. Cytology uncovered the
etiologic agent in 56.1% of all cases and in 71.8% of pulmonary cases.
Cytology also was the first method to disclose the fungus in 57.7% of
pulmonary cases. Sputum was the cytology specimen examined in 51% of
the patients. In 69 patients with lung involvement, pulmonary cytology
was positive in 97% of cases. Wet preparation was the second method
to most commonly uncover the fungus in 37.4% of all cases. Histology
was the third method with 32.5% of positive cases. Cultures were positive
in 64.2% of all cases but they were the first to detect the fungus in
only 3.2% of all patients. There was pulmonary involvement in 87% of
patients, cutaneous involvement in 20%, osseous involvement in 15%,
and central nervous involvement in 3%. In the medical literature the
relative proportion of pulmonary versus disseminated disease clearly
increased in series reported after 1959.
Proportionally to the pattern of patients admitted to the University
of Mississippi Medical Center, there is a clear predominance of black
males among patients with blastomycosis followed by black females. White
females constitute the sex/ethnic group least affected by this fungal
disease. |
|
Blastomycosis: The great pretender can also be an opportunist. Initial
clinical diagnosis and underlying diseases in 123 patients.
Lemos LB, Baliga M, Guo M.
Department of Pathology, University of Texas, Houston; and the Department
of Pathology, University of Mississippi, Jackson. |
Ann Diagn Pathol 2002 Jun;6(3):194-203 Abstract quote
Clinically, blastomycosis can be difficult to recognize even in the
endemic areas where clinicians are aware of this problem. In only 18%
of 123 patients from the University of Mississippi Medical Center (Jackson,
MS) blastomycosis was correctly suspected at the initial patient evaluation.
Pneumonia sensu latu (40%), malignant tumors (16%), and tuberculosis
(14%) were the most common misdiagnoses. The false first impression
frequently resulted in unnecessary surgeries or treatment delays, with
patients receiving inefficient antibiotic therapy for months. The presence
of cutaneous involvement by the disease makes its' recognition easier
for the clinician, raising the percentage of correct initial diagnosis
to 64%. To evaluate the association with immunodepression, the presence
of other diseases was also searched among the 123 patients. An immunodepressive
condition preceded the fungal disease in 25% of patients. Another associated
disease commonly found in blastomycotic patients was diabetes mellitus
(22%).
Blastomycosis is correctly suspected at the first clinical evaluation
in only a small percentage of patients; pneumonia, cancer, and tuberculosis
are the most common clinical considerations. Cutaneous involvement leads
the clinician to the correct diagnosis in the majority of cases. One
fourth of the patients with blastomycosis had underlying immunodepressive
conditions, and underlying diabetes mellitus is present in 22% of patients.
|
| VARIANTS |
|
| BONE |
|
|
Delayed diagnosis of osseous blastomycosis in two patients following
environmental exposure in nonendemic areas.
Veligandla SR, Hinrichs SH, Rupp ME, Lien EA, Neff JR, Iwen
PC.
Department of Internal Medicine, University of Nebraska Medical
Center, Omaha 68198-6495, USA |
Am J Clin Pathol 2002 Oct;118(4):536-41 Abstract quote
Blastomycosis generally results from inhalation of Blastomyces dermatitidis
conidia following exposure to contaminated soil in an endemic area.
Primary infections commonly involve the lungs, although secondary dissemination
to other body sites may occur.
We describe 2 cases of osseous blastomycosis in people living outside
the endemic areas. Both patients reported exposure to soilfollowing
injury to the knee from occupational activities. Mold isolated from
each case was identified as B dermatitidis by micromorphologic characteristics
including yeast conversion testing and by a positive AccuProbe Blastomyces
dermatitidis test (GenProbe, San Diego, CA). Retrospective review of
histologic slides, initially reported as negative, identified rare poorly
staining, broad-based budding yeast forms in each case. Both patients
were treated successfully with itraconazole with no evidence of recurrent
infection after 1 year.
These cases illustrate the importance of considering blastomycosis
in the differential diagnosis of bony lesions, even though the patient
may live outside an endemic area for B dermatitidis. |
| CNS |
|
|
Cerebral blastomycosis. A report of 2 cases.
Cooper K, Lalloo UG, Naran HK.
Department of Anatomical Pathology, University of Natal, Durban. |
S Afr Med J 1988 Nov 19;74(10):521-4 Abstract quote
Following recent documentation of blastomycosis in the RSA, a report
of a further 2 cases in Natal is presented. The unusual feature of both
cases was the presence of central nervous system involvement.
In the first patient intracerebral involvement occurred after apparent
good response to ketoconazole when he defaulted from therapy after 3
months. The second patient presented with cerebral involvement and died
soon after admission to hospital. |
| DISSEMINATED |
|
Disseminated blastomycosis.
Assaly RA, Hammersley JR, Olson DE, Farrouk A, Zaher A, Amurao
GV, Shelley WB, Shelley ED, Amurao CV.
Department of Medicine, Divisions of Pulmonary/Critical Care
and Dermatology, and Department of Pathology, Medical College of Ohio.
|
J Am Acad Dermatol 2003 Jan;48(1):123-7 Abstract quote
A 26-year-old veiled Saudi-Arabian woman presented with hemoptysis,
and multiple nodules and abscesses. A skin biopsy specimen revealed
yeast forms consistent with Blastomyces dermatitidis.
Fungal cultures from bronchoscopy and skin specimens also grew B dermatitidis.
She was treated with oral itraconazole (200 mg twice a day). Both lung
and skin lesions showed improvement within 6 weeks.
|
| LARYNGEAL |
|
|
Laryngeal blastomycosis: a commonly missed diagnosis. Report of two
cases and review of the literature.
Hanson JM, Spector G, El-Mofty SK.
Department of Otolaryngology-Head and Neck Surgery, Washington University
School of Medicine, St. Louis, Missouri, USA. |
Ann Otol Rhinol Laryngol 2000 Mar;109(3):281-6 Abstract
quote
Blastomycosis is a relatively uncommon fungal disease that most commonly
affects the lungs. Other organs may be involved, usually secondary to
dissemination of the organism. Laryngeal blastomycosis may occur in
isolation from active pulmonary disease. The signs, symptoms, clinical
features, and pathological findings of laryngeal blastomycosis mimic
those of squamous cell carcinoma. Misdiagnosis may result in inappropriate
treatment with potential morbidity. Proper understanding of the clinical
presentation and familiarity with the histopathologic features of this
disease are therefore imperative. In this paper, we report 2 cases of
laryngeal blastomycosis, 1 of which was misdiagnosed as squamous cell
carcinoma, clinically and microscopically, with consequent radiotherapy
and laryngectomy. In the other case, a clinical diagnosis of glottic
squamous cell carcinoma was rendered. However, blastomycosis was identified
in a biopsy specimen. We also review cases of isolated laryngeal blastomycosis
that have been reported in the English-language literature during the
last 80 years. A number of those cases were misdiagnosed clinically
and microscopically as squamous cell carcinoma. |
| LUNG |
|
|
Epidemiological and clinical features of pulmonary blastomycosis.
Davies SF, Sarosi GA.
University of Minnesota Medical School, Hennepin County Medical
Center, Minneapolis 55415, USA. |
Semin Respir Infect 1997 Sep;12(3):206-18 Abstract quote
The epidemiological and clinical aspects of Blastomycosis are reviewed.
The central United States is the most heavily endemic area in the world,
although the extent of the endemic zone has been mapped only by individual
case finding, rather than by large skin test surveys (as was done for
histoplasmosis).
The difficulties in developing a sensitive and specific skin test
antigen are reviewed, and the sequence of antigens from Blastomycin
to antigen A to the ASWS (alkali and water soluble) antigen to the WI
(Wisconsin) antigen are discussed. The absence of good immunological
markers of remote subclinical disease means that the size of the iceberg
of subclinical cases relative to clinically apparent and diagnosed pulmonary
and extrapulmonary cases remains uncertain. Clinical presentations of
blastomycosis range from (1) asymptomatic, currently discovered only
in outbreak situation, (2) flulike illness of brief duration resembling
other upper respiratory infections, (3) illness resembling bacterial
pneumonia with acute onset, high fever, lobar infiltrates, and productive
cough, (4) subacute or chronic respiratory illness with symptom complex
resembling tuberculosis or lung cancer and radiographic presentation
of fibronodular infiltrates or mass-like lesions, and (5) fulminant
infectious adult respiratory distress syndrome (ARDS) with high fever,
diffuse infiltrates, and progressive respiratory failure. Radiographic
presentations are highly variable and even more confusing because of
lack of standard terminology to describe these abnormalities.
Examples of some of the radiographic presentations of blastomycosis
are shown. Available information concerning computed tomographic studies
is also reviewed. Special mention is made of blastomycosis in AIDS,
which is uncommon but tends to be fulminant, systemic, and rapidly progressive.
An overview of current diagnostic strategies and treatment options is
also presented. |
| PERITONEAL |
|
|
Peritoneal blastomycosis.
Perez-Lasala G, Nolan RL, Chapman SW, Achord JL.
Division of Infectious Diseases, University of Mississippi Medical
Center, Jackson. |
Am J Gastroenterol 1991 Mar;86(3):357-9 Abstract quote
Blastomycosis is a systemic fungal infection caused by Blastomyces
dermatitidis. Involvement of the peritoneum is unusual, with only two
previously reported cases that occurred in association with disseminated
disease. A single case of histopathologically proven blastomycosis involving
the peritoneum is presented, as well as a short overview of previously
published cases on gastrointestinal and peritoneal blastomycosis. The
case is unique in that chronic peritonitis was the only manifestation
of disease. The diagnosis was made by laparoscopy. |
| SKIN |
|
| Primary Cutaneous infection |
Rare
May occur from traumatic implantation |
| Secondary cutaneous infection |
Hematogenous spread from primary pulmonary infection
Annular, verrucous, or ulcerated plaques or nodules surrounded by a
pustular margin
Central healing with atrophic scarring |
| HISTOLOGICAL TYPES |
CHARACTERIZATION |
| General |
Acute suppurative and granulomatous inflammation
Fungi are usually demonstratable at the edge of the abscess with yeast
cells are globose to ovoid in shape and approximately 8-15 um in diameter
Single blastoconidium is attached by a broad base to the parent cell
In most instances, predominantly single cells without attached blastoconidia
are seen
The cell wall of the yeast is thick and appears doubly refractile |
| LUNGS |
Widespread granulomatous inflammation with small areas of
abscess formation |
|
Giant forms of Blastomyces dermatitidis in the pulmonary lesions of
blastomycosis. Potential confusion with Coccidioides immitis.
Watts JC, Chandler FW, Mihalov ML, Kammeyer PL, Armin AR.
Department of Anatomic Pathology, William Beaumont Hospital,
Royal Oak, Michigan 48072. |
Am J Clin Pathol 1990 Apr;93(4):575-8 Abstract quote
Typical yeast-phase cells of Blastomyces dermatitidis have a characteristic
appearance in tissue sections. Fungal morphologic variation occurs infrequently
in the lesions of blastomycosis, yet it can complicate the differential
diagnosis, particularly if fresh tissue is not available for microbiologic
culture.
The authors report a case of pulmonary blastomycosis, confirmed by
culture and direct immunofluorescence, in which some of the yeast-like
cells were abnormally large. These giant yeast-like cells exceeded the
size range accepted for the tissue forms of B. dermatitidis; therefore,
coccidioidomycosis was considered initially in the differential diagnosis.
Otherwise characteristic morphologic features of these cells, in particular
multinucleation and the production of broad-based blastoconidia, helped
resolve the differential diagnosis.
The diagnosis can be confirmed by direct immunofluorescence or microbiologic
culture. |
| SKIN |
Pseudoepitheliomatous hyperplasia with focal microabscesses in the papillary
dermis |
|
Cutaneous lesions showing giant yeast forms of Blastomyces dermatitidis.
Walker K, Skelton H, Smith K.
Departments of Dermatology and Pathology, University of Alabama
at Birmingham, Birmingham, Alabama, USA. |
J Cutan Pathol 2002 Nov;29(10):616-8 Abstract quote
Background: The yeast forms of Blastomyces dermatitidis usually range
from 8 to 15-20 micro m in diameter. Larger yeast forms have previously
been reported only twice in immunosuppressed patients. In both patients
these large forms were seen within the lung.
Case report: We present a 14-year-old cardiac transplant patient, who
presented 36 days following his transplantation with acute respiratory
distress followed a few days later by erythematous cutaneous papules.
Results: Biopsy of a skin lesion showed yeast forms, some greater than
40 micro m in diameter, within and surrounding dermal vessels. Cultures
later grew Blastomyces dermatitidis.
Conclusion: To our knowledge this is the first reported case of giant
forms of Blastomyces dermatitidis within the skin. With increased iatrogenic
immunosuppression, we may expect to see more diverse morphologic forms
with deep fungal infections. |
| SKIN-SWEET'S SYNDROME-LIKE CHANGES |
|
Sweet's Syndrome-Like Blastomycosis.
Wilkerson A, King R, Googe PB, Page RN, Fulk CS.
|
Am J Dermatopathol 2003 Apr;25(2):152-4 Abstract quote
Cutaneous North American blastomycosis is characterized clinically
by verrucous nodules and histologically by pseudoepitheliomatous hyperplasia,
intraepidermal neutrophilic microabscesses, and a dermal mixed inflammatory
cell infiltrate containing giant cells.
We describe a patient who presented clinically with erythematous nodules
and plaques on the lower extremities characterized histologically by
a diffuse neutrophilic infiltrate, with lack of epidermal hyperplasia.
The lesions were clinically and histologically reminiscent of Sweets
syndrome.
On close microscopic inspection scattered histiocytes and multinucleated
giant cells were present in the dermis, and fungal stains demonstrated
budding yeast forms consistent with Blastomyces sp.
|
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