Cutaneous blastomycosis in New Brunswick: case report

Ross, John J.; Keeling, Douglas N.
November 2000
CMAJ: Canadian Medical Association Journal;11/14/2000, Vol. 163 Issue 10, p1303
Academic Journal
AbstractBlastomycosis is a fungal infection of immunocompetent hosts. We present a case of cutaneous blastomycosis acquired in New Brunswick, which provides evidence that this disease is endemic in Atlantic Canada. This case also demonstrates that the diagnosis of blastomycosis may be elusive. Perseverance, a high index of clinical suspicion and close cooperation with the microbiology laboratory may be required to diagnose this uncommon condition.CaseA 63-year-old man with a painless skin lesion on the right thigh was referred to a dermatologist (D.N.K.) in June 1998. The lesion had started "like a boil," according to the patient, and had enlarged slowly over a period of 1 year; purulent drainage occurred intermittently. He had been treated by other physicians with a succession of oral antibiotics, without improvement.The patient's past medical history was noncontributory. He was otherwise well and denied fever, sweats, anorexia, fatigue and respiratory symptoms. He was a forestry worker and recreational boatsman but could not recall a penetrating injury to the thigh during either activity. He had not travelled outside central New Brunswick since a visit to Ontario in 1993.Skin biopsy in June 1998 revealed necrotizing granulomas. Periodic acid - Schiff and Gram stains did not reveal fungi or bacteria. Specimens sent for bacterial and mycobacterial culture were negative. Fungal cultures, on inhibitory mould agar and brain-heart infusion agar with blood, grew a mould identified as Trichophyton sp., as did cultures of nail clippings, from a toenail with clinical onychomycosis. The patient completed a 12-week course of terbinafine in October 1998, by which time the onychomycosis had resolved; however, the thigh lesion worsened over the course of treatment.The diagnosis of pyoderma gangrenosum was also considered. Workup for underlying occult inflammatory bowel disease yielded negative results. As a therapeutic trial for pyoderma gangrenosum, a small segment of t...


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