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Blastomycosis is a fungal infection caused by Blastomyces dermatitidis. While blastomycosis can cause systemic infection affecting multiple organs, localized blastomycosis of the breast is uncommon. Here, we report the case of a 50-year-old female with a localized left breast growth which started as a nodule and later ulcerated extensively. Although her clinical picture raised concerns for breast malignancy, workup revealed cutaneous blastomycosis with superimposed methicillin-susceptible Staphylococcus aureus and Klebsiella oxytoca infection. Interestingly, there was no evidence of pulmonary disease on CT chest imaging. She was treated with Amphotericin B for seven days and discharged on oral Itraconazole for nine months. Additionally, she received amoxicillin-clavulanate for her bacterial superinfection. On the six-month follow-up, the patient showed significant improvement. Blastomycosis can mimic several diseases including malignancy, pyoderma gangrenosum, and mycobacterial and bacterial infections leading to delayed diagnosis and treatment.

Cutaneous blastomycosis is endemic to North America and is often caused by dimorphic fungi with spores that are inhaled, inoculated spores, or hyphae that infect immunosuppressed and healthy people. It is sporadic and described as a universal imitator with morphological manifestations as erythema, nodules, and ulcers. Our case demonstrated a 69-year-old female bitten by her pet dog who was then diagnosed with cutaneous blastomycosis through social history and detailed laboratory examinations. She experienced a prolonged failure with antibacterial treatment, negative stool and tissue culture, and chronic inflammatory cell infiltrates on tissue pathology. High-throughput sequencing was performed and showed evidence of Blastomyces dermatitidis aetiology. Photodynamic therapy combined with oral itraconazole was administered, and the patient recovered in a short time. Our case presents inoculated cutaneous blastomycosis and a treatment approach in which photodynamic therapy combined with oral itraconazole significantly reduced the duration of disease treatment and affords a promising choice for the treatment of cutaneous blastomycosis.

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.

Highlights • -Blastomycosis is a chronic granulomatous disease that usually starts as a pulmonary infection. • -A high percentage of patients will develop a disseminated disease if the initial lung infection is left untreated. • -Cutaneous blastomycosis is the most common extrapulmonary manifestation. • -Definitive diagnosis requires direct visualization of the yeast at staining or positive fungal culture., Cutaneous blastomycosis is the most common extrapulmonary manifestation of disseminated blastomycosis, a disease caused by Blastomyces dermatitidis, a dimorphic fungus endemic of North America. Initially, the organism enters the respiratory system by inhalation of the infectious conidia and produces an acute pulmonary infection that may eventually disseminate if it is left untreated. Blastomycosis may represent a diagnostic challenge and its definitive diagnosis requires direct visualization of the distinctive yeast or a positive fungal culture. The objective of this case report is to highlight the importance of the skin exam and tissue biopsy in the diagnosis of blastomycosis. We present a previously healthy patient with chronic pneumonia, evaluated at Pulmonary clinic with non-diagnostic thoracentesis and bronchoscopy, found to have disseminated blastomycosis after biopsy of a scalp lesion in Dermatology clinic.

Fungal infections have an important role in organ transplant recipients, and in some cases can be lethal. Blastomycosis is rare in kidney transplantation. We present a case of cutaneous blastomycosis in a kidney transplant recipient in Tunisia, a country outside the known endemic countries. This case, with the very uncommon and unexpected diagnosis of blastomycosis, demonstrates the diversity of infections in transplant recipients and reflects the importance of histologic and serologic tests in the immunocompromised patient.

This is a case report of concurrent of blastomycosis and pseudomycetoma in a 3 year-old Persian cat from Bangkok, Thailand. Histopathology from antemortem and postmortem samples revealed blastomycosis and dermatophyte pseudomycetoma. The PCR analysis of the formalin-embedded tissue of antemortem sample confirmed that blastomycosis was caused by Blastomyces dermatitidis. Dermatophyte infection was caused by Microsporum canis. According to the author's knowledge, this is the first case of Blastomyces dermatitidis and dermatophyte pseudomycetoma in South-East Asia.

Blastomycosis is a primary pulmonary mycosis of humans usually affecting patients geographically located near the Great Lakes, Lake-of-the-Woods and northern Ontario. We report a case of cutaneous blastomycosis in a patient with no environmental contact outside of Saskatchewan.

This is the first case report from Turkey to describe a renal transplant complicated by subcutaneous blastomycosis and BK infection. The cutaneous lesions were successfully treated with amphotericin B and fluconazole. The presence of BK infection led to graft failure. Infections with uncommonly seen organisms should be kept in mind due to the impaired T-cell immunity in transplantation.

Cutaneous blastomycosis lesion is most often originate from a Primary pulmonary infection which disseminates through the blood or lymphatics to involve the skin. During the manifestations of cutaneous lesion in case of secondary blastomycosis, the primary pulmonary infection is frequently subclinical. Here we report a case that illustrates the difficulty in diagnosing a case of cutaneous blastomycosis.Northern International Medical College Journal Vol.8(1) July 2016: 189-191

Blastomycosis is a dimorphic fungus caused by the species of Blastomyces dermatitidisand Blastomyces gilchristii, which are endemic to the Ohio River and Mississippi River Valleys. It is commonly found in soil or decomposing wood. It is capable of infecting both immunocompromised and immunocompetent patients via the respiratory tract by inhaling conidia, where it may remain asymptomatic for a prolonged period of time. Extrapulmonary complications can occur in disseminated disease due to haematogenous spread from the lungs to other organ systems. Haematogenous dissemination from the lungs occurs most commonly to the skin. Although rare, primary cutaneous blastomycosis can also occur with direct inoculation through the trauma of the skin. Patients presenting with cutaneous blastomycosis are often misdiagnosed with malignant neoplasms and may not be appropriately managed until further testing and tissue biopsy. Currently, there are only four previous case reports of blastomycosis presenting in the intranasal region. We report two cases of cutaneous blastomycosis of the nasal passages and upper lip with pulmonary manifestations in Southern West Virginia. These patients first presented with cutaneous symptoms, which were originally treated for melanoma and squamous cell carcinoma and were later diagnosed with systemic blastomycosis.

Summary This report describes the case of a horse presented with cutaneous lesions caused by Blastomyces dermatitidis in the absence of signs of other organ involvement. Diagnosis was achieved through cytology, histopathology and culture. Surgical debulking associated with systemic therapy with oral fluconazole resulted in significant remission; however, recurrence occurred following presumed early cessation of treatment.

Cutaneous blastomycosis (CB) is associated with a variety of skin manifestations. Among other entities, CB may be mistaken for pyoderma gangrenosum due to overlap of findings on histopathologic examination. We report a case of CB, initially diagnosed as pyoderma gangrenosum and treated with steroids, leading to disseminated blastomycosis and acute respiratory distress syndrome (ARDS).

Background Blastomycosis is a commonly misdiagnosed infection caused by Blastomyces spp. It is not reportable in New York State (NYS), but where reportable, yearly incidence is 1–2/100,000 persons. In October 2017, a physician notified the NYS Department of Health (NYSDOH) of six blastomycosis cases seen during April 2016–July 2017 in the nonendemic eastern upstate area known as the Capital District (CD). NYSDOH investigated to determine the possibility of locally acquired blastomycosis. Methods NYS hospital blastomycosis discharge codes from the January 2007–December 2016 Statewide Planning and Research Cooperative System dataset were reviewed. To better understand illness in the area of highest incidence, NYSDOH contacted CD physicians to identify patients diagnosed with blastomycosis during April 2016–February 2018. Chart reviews and interviews were conducted to obtain travel and disease progression details. Results During 2007–2016, there were 279 blastomycosis diagnoses in NYS. Mean annual blastomycosis diagnoses during 2007–2015 was 24 (incidence: 0.1/100,000 persons); in 2016, there were 59 blastomycosis diagnoses (incidence: 0.3/100,000 persons). A CD county had the highest state incidence, with a rate increase from 2.0/100,000 persons during 2007–2015 to 4.1/100,000 persons during 2016. CD physicians provided contact and clinical information for the six initially-identified patients and two additional patients seen during April 2016–February 2018. All experienced delays in diagnosis, seven lacked travel history, two had cutaneous blastomycosis, three had pulmonary blastomycosis, and three had disseminated blastomycosis. One died from blastomycosis and another required long-term ventilator support. Seven cases were identified by culture or histopathology; the diagnostic method for one was unknown. Conclusion One CD county had blastomycosis rates similar to known endemic areas; patients lacked travel history to endemic areas, indicating locally acquired blastomycosis might have occurred. To improve prompt diagnosis, NYS clinicians and laboratorians should consider blastomycosis in patients with pneumonia, even without travel history to endemic areas. Further evaluation is needed to determine whether the endemic area of NYS has expanded. Disclosures All authors: No reported disclosures.

Primary cutaneous inoculation blastomycosis occurs less commonly than secondary blastomycosis, in which cutaneous lesions most often originate from a primary pulmonary infection which disseminates through the blood or lymphatics to involve the skin. In secondary cutaneous blastomycosis, the primary pulmonary infection is frequently subclinical at the time cutaneous lesions manifest. Here we report two cases that illustrate the difficulty in distinguishing between primary and secondary cutaneous involvement. We also review the expanding literature on blastomycosis since its identification over a century ago.

We present an interesting case of chronic cutaneous blastomycosis occurring in a 71-year-old veterinarian diagnosed by morphologic examination, highlighting the clinical presentation, morphologic appearance, and treatment of chronic cutaneous blastomycosis. This case emphasizes the importance of careful clinicopathologic correlation and morphologic examination in diagnosing cutaneous blastomycosis.

Three dogs treated for systemic blastomycosis with intravenous amphotericin B (one case) or amphotericin B lipid complex (two cases) developed mild to severe calcinosis cutis two to six weeks after the initiation of treatment. Abnormalities in serum calcium and phosphorus during treatment for blastomycosis or at the time of diagnosis of calcinosis cutis were slight or absent. The calcification was not associated with lesions of cutaneous blastomycosis. Calcification was limited to the skin in two cases and may have also involved the kidneys in one. The calcinosis cutis resolved completely in all three dogs with no (two cases) or only palliative (one case) therapy.

Blastomycosis is a rare mycotic infection in Africa. Isolated cutaneous disease is extremely rare. We report three cases of cutaneous blastomycosis confirmed by istologic and mycologic examination. No visceral involvement was found. Blastomycosis is rare in Tunisia. The most common site of involvement is the lung. The three cases reported presented with skin involvement only, suggesting a cutaneous inoculation of Blastomyces dermatitidis. The diagnostic criteria of cutaneous blastomycosis are discussed.

The case of a 63-year-old carpenter with cutaneous blastomycosis is presented. The patient contracted the disease in 1974 when his leg was injured by a piece of rotten wood during repair works in deep cellars in Lublin's Old Town. Six months later a nodular lesion extending peripherally with hyperkeratosis developed at the site of the injury. The lesions slowly spread to cover more than half of the skin surface of the body. Some of them had regressed spontaneously, leaving cicatrization. Initially, anti-inflammatory treatment was given. Ten years later, in 1984, antimycotic therapy with various antifungal agents was instituted. Improvement appeared to be greatest with fluconazole treatment.

Blastomycosis is an infection that is often associated with recent military, occupational, or recreational activities near damp soil in various endemic regions, including the Great Lakes and major river valleys in the Midwest as well as various overseas regions. In the great majority of cases, the disease presents as a primary pulmonary disease with or without extrapulmonary involvement. We present a case of cutaneous blastomycosis with no evidence of pulmonary or other systemic involvement. With such presentations, the disease is presumed to have spread hematogenously with the asymptomatic or minimal primary pulmonary infection having resolved spontaneously. The patient's diagnosis was made with positive cultures and histologic examinations revealing features that are quite characteristic of blastomycosis. The patient responded to treatment with itraconazole for 6 months with no recurrence after 1 year. A high index of suspicion must be maintained when evaluating patients with progressive ulcerating or verrucous lesions that do not respond to traditional antibiotic therapy, especially with a history of recent activities in the endemic regions.

Blastomycosis, usually presenting as pneumonia, is more common in adults than in children. Moreover, cutaneous blastomycosis is quite uncommon in children. We describe a case of cutaneous blastomycosis in an 8-year-old boy who presented with multiple hyperkeratotic verrucous plaques where diagnosis was made on fine-needle aspiration cytology, and the infection responded well to oral itraconazole therapy with reduction in number of spores and size of lesions.

Primary cutaneous blastomycosis is a rare infection of the skin that usually follows trauma and presents as a papule or nodule that ulcerates. Although this infection often heals spontaneously, we present a case of a nonhealing ulcer following surgical drainage of cellulitis. Blastomycosis was diagnosed by histopathological examination and the infection responded well to oral ketoconazole therapy.

Fungal pathogens can be the source of serious and sometimes fatal infections following organ transplantation. To the best of our knowledge, we present the first case of cutaneous blastomycosis in a renal allograft recipient in India, a country outside the known endemic regions. This case, with the very rare and unexpected diagnosis of blastomycosis, not only reflects the tremendous diversity of infections in transplant recipients but also emphasizes the utility of serological methods even in the immunosuppressed host.

This report describes the macro- and microscopic characteristics of a strain of Blastomyces dermatitidis isolated in an Italian hospital from a Libyan patient suffering from cutaneous blastomycosis. The fungus was isolated with great difficulty because of the presence of a Proteus species on the lesion. Conversion of the mycelial into the yeast-like phase achieved the best results, using Columbia ANC culture medium. After 5-6 days, this transformation was only partial and presented swollen hyphae and yeast-like cells. The biological characteristics were typical of B. dermatitidis strains of African origin. The differences between African and North American strains are confirmed, in agreement with findings already reported in the literature.

SIR, – I recently removed a growth from the right lip of a seven-year-old male neutered cat. The lesion was not dissimilar to an eosinophilic granuloma. According to the histology report, the lesion was suggestive of an infection with Blastomyces species. I have not come across this finding

A case of atypical cutaneous blastomycosis is reported. Patient responded to oral fluconazole 200 mg per day given for 9 months.

A patient who worked as a landscaper had a solitary lesion of cutaneous blastomycosis on the foot at a site of abrasion from the bark of a tree shrub. The authors postulate that the patient’s disease was caused by direct inoculation. The lesion was vaporized with the carbon dioxide laser after initiating systemic ketoconazole therapy.