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Li MM, Ortega-Loayza AG, Chisholm C, Tolkachjov SN. Solitary Ulcerated and Verrucous Plaque With Violaceous Borders: Answer. Am J Dermatopathol 2024; 46:126-127. [PMID: 38275238 DOI: 10.1097/dad.0000000000002599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- May M Li
- Department of Internal Medicine, Creighton University, Omaha, NE
| | | | | | - Stanislav N Tolkachjov
- Epiphany Dermatology, Dallas, TX
- Department of Dermatology, University of Texas at Southwestern, Dallas, TX
- Texas A&M College of Medicine, Dallas, TX; and
- Baylor University Medical Center, Dallas, TX
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2
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Gamaletsou MN, Rammaert B, Brause B, Bueno MA, Dadwal SS, Henry MW, Katragkou A, Kontoyiannis DP, McCarthy MW, Miller AO, Moriyama B, Pana ZD, Petraitiene R, Petraitis V, Roilides E, Sarkis JP, Simitsopoulou M, Sipsas NV, Taj-Aldeen SJ, Zeller V, Lortholary O, Walsh TJ. Osteoarticular Mycoses. Clin Microbiol Rev 2022; 35:e0008619. [PMID: 36448782 PMCID: PMC9769674 DOI: 10.1128/cmr.00086-19] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. Candida osteomyelitis and Candida arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of Candida and Aspergillus arthritis. Relapsed infection, particularly in Candida arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.
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Affiliation(s)
- Maria N. Gamaletsou
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Blandine Rammaert
- Université de Poitiers, Faculté de médecine, CHU de Poitiers, INSERM U1070, Poitiers, France
| | - Barry Brause
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Marimelle A. Bueno
- Far Eastern University-Dr. Nicanor Reyes Medical Foundation, Manilla, Philippines
| | | | - Michael W. Henry
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aspasia Katragkou
- Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University School of Medicine, Columbus, Ohio, USA
| | | | - Matthew W. McCarthy
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Andy O. Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Zoi Dorothea Pana
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Ruta Petraitiene
- Weill Cornell Medicine of Cornell University, New York, New York, USA
| | | | - Emmanuel Roilides
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | | | - Maria Simitsopoulou
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Nikolaos V. Sipsas
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Valérie Zeller
- Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Olivier Lortholary
- Université de Paris, Faculté de Médecine, APHP, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, CNRS UMR 2000, Paris, France
| | - Thomas J. Walsh
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
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3
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Shah H, Carstensen T, Kmeid M, Bialowas C. Cutaneous Blastomycosis Presenting as a Nonhealing Wound in the Northeast United States: A Case Report. INT J LOW EXTR WOUND 2022:15347346221140782. [PMID: 36426539 DOI: 10.1177/15347346221140782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
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.
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Affiliation(s)
| | - Teresa Carstensen
- Division of Plastic & Reconstructive Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - Michel Kmeid
- Department of Pathology, 138207Albany Medical Center, Albany, NY, USA
| | - Christie Bialowas
- Division of Plastic & Reconstructive Surgery, 138207Albany Medical Center, Albany, NY, USA
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Muacevic A, Adler JR. Disseminated Blastomycosis in an Immunocompetent Patient. Cureus 2022; 14:e30391. [PMID: 36407244 PMCID: PMC9668325 DOI: 10.7759/cureus.30391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 01/25/2023] Open
Abstract
Blastomycosis is caused by Blastomyces dermatitidis, which is endemic in certain areas in North America. It usually causes lung infection, and it can disseminate to other organs in immunocompromised individuals. Common sites for dissemination include skin, central nervous system (CNS), and bone. Dermatological spread is the commonest site for extrapulmonary spread. The diagnosis can be easily missed due to nonspecific presentation and variable dermatological presentations. Treatment is necessary even if the patient has improvement in symptoms without previous treatment. We present a case of disseminated blastomycosis in a 40-year-old male without known risk factors that went undiagnosed for over a year.
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Agarwal A, Kar B. Amphotericin-B in dermatology. Indian Dermatol Online J 2022; 13:152-158. [PMID: 35198495 PMCID: PMC8809177 DOI: 10.4103/idoj.idoj_573_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 11/23/2022] Open
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Challenges in diagnosis of limited granulomatosis with polyangiitis. Rheumatol Int 2021; 41:1337-1345. [PMID: 33939014 DOI: 10.1007/s00296-021-04858-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/01/2021] [Indexed: 01/06/2023]
Abstract
Granulomatosis with polyangiitis (GPA) is an orphan disease with multifaceted clinical presentations and delayed diagnosis. Given the risks of delayed diagnosis and treatment, improving clinicians' awareness of atypical course of this disease is critically important. The aim of this report is to analyze a case of delayed diagnosis of GPA in view of similar publications. We analyzed articles retrieved from Scopus and MEDLINE/PubMed. The following keywords were used: "granulomatosis with polyangiitis", "Wegener granulomatosis", and "diagnostic errors". All case studies that fulfilled the Chapel Hill Consensus Conference and the American College of Rheumatology GPA criteria were retrieved. We report a 71-year-old female patient with a facial defect in the nasal region, nasal congestion, and serosanguineous discharge. Her final diagnosis of GPA was reached after a series of incorrect diagnoses in the past 40 years. A deforming facial lesion developed during this period of uncertainty and absence of appropriate treatment. This patient presented with atypical features of laboratory and instrumental examinations. Anti-neutrophil cytoplasmic antibodies (ANCA) were negative, while rheumatoid factor (RF; 46.3 IU/mL) and anti-citrullinated protein antibody (ACPA; 25.6 IU/mL) were elevated. The histological analysis of the nasal mucous membrane specimen did not indicate definite signs of vasculitis. However, it revealed a granuloma with aggregation of macrophages and massive infiltration of lymphocytes, ruling out previous diagnosis of carcinoma. We analyzed delayed diagnosis of GPA in our patient in the context of 12 previously reported similar cases of limited form of GPA. We emphasize the importance of histological examination for differential diagnosis of GPA.
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Enigmatic Rapidly Enlarging Nasal Mass That Is Not Cancer. Case Rep Dermatol Med 2020; 2020:8855572. [PMID: 32908718 PMCID: PMC7471822 DOI: 10.1155/2020/8855572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/04/2020] [Accepted: 08/14/2020] [Indexed: 11/21/2022] Open
Abstract
Cutaneous blastomycosis is not rare, but progressively enlarging nasal mass as the only presentation with nondiagnostic biopsy results, presence of pulmonary fibrosis, nodules and lymphadenopathy, and urinary sediments, as well as ANA and p-ANCA positivity, can make things more cryptic than expected.
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Yan L, Rohra P, Cheng L, Gattuso P. Pleural Effusion in Pulmonary and Extrapulmonary Blastomycosis. Acta Cytol 2019; 64:241-247. [PMID: 31266012 DOI: 10.1159/000500973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/14/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Pleural effusion secondary to blastomycosis infection is an uncommon clinical manifestation of the disease. We undertook a retrospective study to assess the incidence and involvement of pleural effusion in patients with blastomycosis infection. STUDY DESIGN Institutional cytology and surgical pathology records were searched from December 1995 to October 2017 for cases of blastomycosis. The cytologic, surgical pathology, and clinical pertinent information was reviewed in detail. RESULTS A total of 77 cases of blastomycosis infection were recorded, with a male-to-female ratio of 1.7:1.0. Forty-eight cases of blastomycosis were pulmonary (62.3%), while 29 cases of blastomycosis were found in extrapulmonary sites (37.7%). The diagnosis of pulmonary blastomycosis was established by 24 lung biopsies/wedge resections, 22 bronchial alveolar lavages, and 2 lung fine needle aspirations. The 29 cases of extrapulmonary blastomycosis included 13 cases of bone (44.8%), 8 cases of skin (27.6%), 6 cases of soft tissue (20.7%), and 2 cases of brain infections (6.8%). Twenty-eight of 48 pulmonary cases were complicated by unilateral or bilateral pleural effusion (58.3%) detected by imaging studies. Four of the 28 pleural effusions were aspirated and examined by cytology. Two of the 4 pleural fluid cytologies showed involvement by blastomycosis (50%). In the extrapulmonary blastomycosis group, 9 of 29 patients showed unilateral or bilateral pleural effusions (31.0%), including 4 cases of bone, 4 cases of skin, and 1 case of brain involvement. Only 2 of the 9 pleural effusions were aspirated for cytology study. One of the 2 pleural fluid cytologies showed blastomycosis (50%). CONCLUSION Pleural effusion detected by imaging is common in blastomycosis patients. Blastomycosis can involve pleural fluid in both pulmonary and extrapulmonary diseases. A broad infectious differential that includes blastomycosis should be considered to make a timely diagnosis and initiate antifungal therapy to prevent systemic infection and further dissemination of the disease.
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Affiliation(s)
- Lei Yan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA,
| | - Prih Rohra
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Lin Cheng
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
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9
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Lohrenz S, Minion J, Pandey M, Karunakaran K. Blastomycosis in Southern Saskatchewan 2000-2015: Unique presentations and disease characteristics. Med Mycol 2018; 56:787-795. [PMID: 29924358 DOI: 10.1093/mmy/myx131] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/28/2017] [Indexed: 11/14/2022] Open
Abstract
In the literature, cases of blastomycosis in Canada have been documented in provinces bordering the Great Lakes, including Ontario and Quebec, as well as Manitoba. This is the first study to our knowledge reporting cases of mycosis seen in southern Saskatchewan suggesting a broader area of endemicity. We searched the Regina Qu'Appelle Health Region (RQHR) Microbiology Laboratory for all culture-confirmed cases of Blastomyces from January 2000 to December 2015 and identified 15 cases. Thirteen cases were reviewed, identifying common presenting symptoms, misdiagnosis, comorbidities, travel history, time from presentation to diagnosis, diagnostic specimen, treatment, and clinical outcome. Nine patients had no travel to areas known to be endemic to environmental blastomycosis. Eight patients presented with respiratory symptoms, four with skin lesions, four with constitutional symptoms, and one presented with chest pain after a fall. Initial misdiagnosis occurred in nine (69%) of the 13 cases, and all six patients that died of the disease were misdiagnosed. These six patients (46%) were acutely ill with refractory disseminated disease, leading to respiratory failure. It is probable that Blastomyces is present as an endemic fungus in the soil of southern Saskatchewan. Possibly due to a lack of awareness of this pathogen in the area, initial misdiagnoses were common and likely contributed to significant morbidity and mortality.
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Affiliation(s)
- Sarah Lohrenz
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jessica Minion
- Dept of Laboratory Medicine, Regina Qu'Appelle Health Region, Regina, SK, Canada.,Dept of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Mamata Pandey
- Dept of Research and Performance Support, Regina Qu'Appelle Health Region, Regina, SK, Canada
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10
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Wang CX, Anadkat MJ. SnapshotDx Quiz: January 2018. J Invest Dermatol 2017; 138:e9. [PMID: 29273152 DOI: 10.1016/j.jid.2017.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Cynthia X Wang
- Washington University School of Medicine, St Louis, Missouri
| | - Milan J Anadkat
- Washington University School of Medicine, St Louis, Missouri; Division of Dermatology, St Louis, Missouri.
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11
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Alvarenga JALDS, Martins DE, Kanas M, Elizeche HGK, Dell'Aquila AM, Fernandes EDA, Wajchenberg M, Puertas EB. Paracoccidioidomycosis in the spine: case report and review of the literature. SAO PAULO MED J 2016; 134:263-267. [PMID: 27355801 PMCID: PMC10496604 DOI: 10.1590/1516-3180.2015.02691801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 01/18/2016] [Indexed: 11/21/2022] Open
Abstract
CONTEXT: Paracoccidioidomycosis is a systemic form of mycosis that spreads hematogenously, secondarily to reactivation of lung infection or infection at another site or to new exposure to the causative agent. Few cases of bone involvement have been reported in the literature and involvement of the spine is extremely rare. CASE REPORT: We describe a case of a 68-year-old male patient with spondylodiscitis at the levels L4-L5 caused by presence of the fungus Paracoccidioides brasiliensis, which was diagnosed through percutaneous biopsy. The patient was treated with sulfamethoxazole and trimethoprim for 36 months, with complete resolution of the symptoms. CONCLUSION: Spondylodiscitis caused by the fungus Paracoccidioides brasiliensis is uncommon. However, in patients with chronic low-back pain who live or used to live in endemic regions, this infection should be considered as a possible differential diagnosis.
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Affiliation(s)
| | - Délio Eulálio Martins
- MD, PhD. Attending Physician, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Michel Kanas
- MD. Spine Resident, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Hugo Gustavo Kunzle Elizeche
- MD. Spine Fellow, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Adriana Macêdo Dell'Aquila
- MD, PhD. Infectious Disease Specialist, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Eloy De Avila Fernandes
- MD, PhD. Affiliated Professor, Department of Imaging Diagnostics, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Marcelo Wajchenberg
- MD, PhD. Affiliated Professor, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Eduardo Barros Puertas
- MD, PhD. Full Professor, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
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12
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Federer AE, Haughom BD, Levy DM, Riff AJ, Nho SJ. Blastomyces Tenosynovitis of the Foot and Ankle: A Case Report and Review of the Literature. J Foot Ankle Surg 2015. [PMID: 26215556 DOI: 10.1053/j.jfas.2015.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Deep fungal infection localized to the foot is not common, and when it occurs it often affects immunocompromised individuals. In this report, we describe the case of an adult diabetic patient who suffered with with Blastomycosis infection of the flexor digitorum longus and peroneal tendon sheaths. The condition was treated with systemic antifungal therapy and surgical debridement.
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Affiliation(s)
- Andrew E Federer
- Orthopaedist, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.
| | - Bryan D Haughom
- Orthopaedist, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, IL
| | - David M Levy
- Orthopaedist, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, IL
| | - Andrew J Riff
- Orthopaedist, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, IL
| | - Shane J Nho
- Assistant Professor, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, IL
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Surprenant D, Kaniszewska M, Hutchens K, Go C, O'Keefe P, Swan J, Tung R. Blastomycosis and Pregnancy: An Unusual Postpartum Disease Course. Case Rep Dermatol 2015; 7:107-12. [PMID: 26120305 PMCID: PMC4478327 DOI: 10.1159/000431033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Blastomyces dermatitidis is responsible for systemic mycoses. It is predominantly caused by inhalation of spores and often manifests as pneumonia, which can potentially disseminate; however, direct cutaneous inoculation may also occur. Blastomycosis in the perigravid period is exceedingly rare. The partial immunosuppressive state induced by pregnancy can engender more severe infections and is associated with a risk of vertical transmission. Published cases describe postpartum symptomatic improvement accompanying immune reconstitution, even in the absence of treatment. We present a 31-year-old gravid female with multifocal cutaneous blastomycosis. After delivering a healthy full-term infant with no evidence of congenital infection, the patient's cutaneous lesions continued to worsen. At 6 weeks postpartum she was treated with oral itraconazole and demonstrated clinical improvement after 5 months of therapy. This case highlights the importance of prompt disease recognition, understanding of risk factors and initiation of appropriate antifungal therapy of blastomycotic infection occurring in the unique setting of pregnancy.
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Affiliation(s)
- David Surprenant
- Divisions of Dermatology, Loyola University Medical Center, Maywood, Ill., USA
| | - Monika Kaniszewska
- Divisions of Dermatology, Loyola University Medical Center, Maywood, Ill., USA
| | - Kelli Hutchens
- Divisions of Pathology, Loyola University Medical Center, Maywood, Ill., USA
| | - Christine Go
- Divisions of Dermatology, Loyola University Medical Center, Maywood, Ill., USA
| | - Paul O'Keefe
- Divisions of Infectious Diseases, Loyola University Medical Center, Maywood, Ill., USA
| | - James Swan
- Divisions of Dermatology, Loyola University Medical Center, Maywood, Ill., USA
| | - Rebecca Tung
- Divisions of Dermatology, Loyola University Medical Center, Maywood, Ill., USA
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Affiliation(s)
- J. H. Wilson
- Turner Wilson Equine Consulting; Stillwater Minnesota USA
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