TITLE

Novel cases of blastomycosis acquired in Toronto, Ontario

AUTHOR(S)
Lester, Robert S.; DeKoven, Joel G.; Kane, Julius; Simor, Andrew E.; Krajden, Sigmund; Summerbell, Richard C.
PUB. DATE
November 2000
SOURCE
CMAJ: Canadian Medical Association Journal;11/14/2000, Vol. 163 Issue 10, p1309
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
AbstractBlastomycosis, a potentially fatal fungal disease, is well known from defined areas of endemicity in Ontario, primarily in the northern part of the province. We present 2 unusual cases that appear to extend the area of endemicity into urban southern Ontario, specifically Toronto. Both patients presented to a dermatology clinic with skin lesions. Chest radiography, history and general physical evaluation indicated no disease at other body sites. Both cases appeared to represent "inoculation blastomycosis" connected with minor gardening injuries and a cat scratch respectively. Atypical dissemination could not be completely excluded in either case. Neither patient had travelled recently to a known area of high endemicity for blastomycosis, nor had the cat that was involved in one of the cases. Physicians must become aware that blastomycosis may mimic other diseases, including dermal infections, and may occur in patients whose travel histories would not normally suggest this infection.Case 1The patient was a 59-year-old immunocompetent woman with no history of recent travel to known areas of endemicity for blastomycosis. She had, however, been gardening in a ravine area of western Toronto near a stream.In March 1998 a lesion developed over the patient's right lateral malleolus, gradually increasing in size. She described the initial lesion as being similar to a pimple. Approximately 2 months later, similar lesions developed on 2 fingers. Several biopsies revealed no distinctive features. A variety of antimicrobial agents were administered without effect. She was referred to a dermatology centre.Dermatological examination indicated a large, erythematous, scaling plaque on the right lateral malleolus and verrucous, indurated lesions on the left index and right ring fingers. The areas surrounding the plaques were slightly violaceous, and pressure led to purulent discharge. Samples were obtained for repeat biopsy. Histopathologic findings were interpreted as...
ACCESSION #
3766899

 

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