A 25 y.o. male presents with pain in the finger and lesions near the corner of his mouth
What is a unifying diagnosis? There is no history of trauma.
lesions near the corner of the mouth on the left.
Our patient had disseminated blastomycosis. This is a pulmonary disease in 79% of cases Occasionally the fungi spread hematogenously causing extrapulmonary disease as in the case of our patient. It is caused by inhaling spores of Blastomyces dermatitis which is found in the soil of the Ohio and Mississippi River valleys and Great Lakes.
Our patient’s history began nine months pta when he presented to an outside hospital with pneumonia and was treated with antibiotics. He never fully recovered and began to have lesions on his skin. His fifth finger began to swell and four months pta, an xray of his finger showed osteomyelitis. A bone biopsy showed Blastomycosis. This indolent time course is not unusual for blastomycosis.
In the body Blastomycosis assumes the yeast form while in the soil it is in a hyphal form.
As shown above; in the body Blastomycosis assumes a budding yeast form while in the soil, it is in a hyphal form. While demonstration of the yeast form provides a conclusive diagnosis; antibody tests and immunoassays are available. The sensitivity and specificity of these tests are low and there is cross-reactivity with histoplasmosis which is also common.
FUN FACTS
It is not clear why hyperendemic areas exist in some cities. In some cases as in Westmont Illinois, construction dust was found to be the cause of an outbreak. Rockford Illinois is also an area with an unusually high number of cases.
Blastomycosis affects a broad range of mammals including dogs which are an order of magnitude more likely to contract the disease than humans. It is reported to be transmitted to humans by the bite of an infected dog.
Open-mouth ventrodorsal skull radiograph of a 2-year-old female intact German Shorthaired Pointer.(above) Note the soft tissue swelling and increased opacity of the right nasal cavity with destruction of nasal turbinates and surrounding bony structures as well as tooth loss secondary to Blastomyces osteomyelitis.
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Klein B, Vergeront J, Weeks R, et al. Isolation of Blastomyces dermatitidis in soil with a large outbreak of blastomycosis in Wisconsin. 1986 NEJM 314(9):529-70.
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