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Thinking Beyond Bacterial Infection: A Case of Cutaneous Blastomycosis

Blastomycosis is caused by Blastomyces dermatitidis, a dimorphic fungus that primarily causes pulmonary disease. Cutaneous blastomycosis is infrequent and tends to be misdiagnosed given its similar presentation to other cutaneous fungal infections and malignancies. A 51-year-old woman presented with...

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Autores principales: Bhatia, Mehakmeet, Kak, Vivek, Patel, Parth, Slota, Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8881278/
https://www.ncbi.nlm.nih.gov/pubmed/35233312
http://dx.doi.org/10.7759/cureus.21634
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author Bhatia, Mehakmeet
Kak, Vivek
Patel, Parth
Slota, Alexander
author_facet Bhatia, Mehakmeet
Kak, Vivek
Patel, Parth
Slota, Alexander
author_sort Bhatia, Mehakmeet
collection PubMed
description Blastomycosis is caused by Blastomyces dermatitidis, a dimorphic fungus that primarily causes pulmonary disease. Cutaneous blastomycosis is infrequent and tends to be misdiagnosed given its similar presentation to other cutaneous fungal infections and malignancies. A 51-year-old woman presented with a two-month history of disfiguring nasal lesions. The patient had a past medical history of cervical cancer which was currently in remission. Social history was significant for frequent travel throughout the United States as a truck driver, including the Midwest. The patient had a non-purulent verrucous plaque on her right nare, which was painless and mildly pruritic. Superficial cultures grew Enterococcus faecalis, prompting treatment with oral cephalexin and topical mupirocin. Given no relief, the patient was started on clindamycin followed by Augmentin. Both treatments were unsuccessful.  The lesion was then biopsied and fungal cultures were sent. The biopsy showed broad-based budding yeast surrounded by pseudoepitheliomatous hyperplasia, and cultures grew Blastomyces dermatitidis. The patient was initiated on 200 mg itraconazole thrice daily for the first three days, followed by 200 mg itraconazole twice daily for the next 12 months. She showed notable improvement within a month. This patient was initially misdiagnosed with bacterial infection due to superficial cultures, which were likely a contaminant. It was only after a biopsy that the patient was accurately diagnosed. Besides bacterial infection, cutaneous blastomycosis is often confused with coccidioidomycosis, mycobacterial infection, or squamous cell carcinoma. In patients such as ours who are presenting with persistent facial lesions in the setting of frequent travel history, fungal etiologies should be high on the differential. A biopsy and fungal cultures should be sent at the outset for accurate diagnosis and treatment.
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spelling pubmed-88812782022-02-28 Thinking Beyond Bacterial Infection: A Case of Cutaneous Blastomycosis Bhatia, Mehakmeet Kak, Vivek Patel, Parth Slota, Alexander Cureus Dermatology Blastomycosis is caused by Blastomyces dermatitidis, a dimorphic fungus that primarily causes pulmonary disease. Cutaneous blastomycosis is infrequent and tends to be misdiagnosed given its similar presentation to other cutaneous fungal infections and malignancies. A 51-year-old woman presented with a two-month history of disfiguring nasal lesions. The patient had a past medical history of cervical cancer which was currently in remission. Social history was significant for frequent travel throughout the United States as a truck driver, including the Midwest. The patient had a non-purulent verrucous plaque on her right nare, which was painless and mildly pruritic. Superficial cultures grew Enterococcus faecalis, prompting treatment with oral cephalexin and topical mupirocin. Given no relief, the patient was started on clindamycin followed by Augmentin. Both treatments were unsuccessful.  The lesion was then biopsied and fungal cultures were sent. The biopsy showed broad-based budding yeast surrounded by pseudoepitheliomatous hyperplasia, and cultures grew Blastomyces dermatitidis. The patient was initiated on 200 mg itraconazole thrice daily for the first three days, followed by 200 mg itraconazole twice daily for the next 12 months. She showed notable improvement within a month. This patient was initially misdiagnosed with bacterial infection due to superficial cultures, which were likely a contaminant. It was only after a biopsy that the patient was accurately diagnosed. Besides bacterial infection, cutaneous blastomycosis is often confused with coccidioidomycosis, mycobacterial infection, or squamous cell carcinoma. In patients such as ours who are presenting with persistent facial lesions in the setting of frequent travel history, fungal etiologies should be high on the differential. A biopsy and fungal cultures should be sent at the outset for accurate diagnosis and treatment. Cureus 2022-01-26 /pmc/articles/PMC8881278/ /pubmed/35233312 http://dx.doi.org/10.7759/cureus.21634 Text en Copyright © 2022, Bhatia et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Dermatology
Bhatia, Mehakmeet
Kak, Vivek
Patel, Parth
Slota, Alexander
Thinking Beyond Bacterial Infection: A Case of Cutaneous Blastomycosis
title Thinking Beyond Bacterial Infection: A Case of Cutaneous Blastomycosis
title_full Thinking Beyond Bacterial Infection: A Case of Cutaneous Blastomycosis
title_fullStr Thinking Beyond Bacterial Infection: A Case of Cutaneous Blastomycosis
title_full_unstemmed Thinking Beyond Bacterial Infection: A Case of Cutaneous Blastomycosis
title_short Thinking Beyond Bacterial Infection: A Case of Cutaneous Blastomycosis
title_sort thinking beyond bacterial infection: a case of cutaneous blastomycosis
topic Dermatology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8881278/
https://www.ncbi.nlm.nih.gov/pubmed/35233312
http://dx.doi.org/10.7759/cureus.21634
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