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Disseminated Blastomycosis in a Teenager Presenting with Pleural Effusion and Splenomegaly. J Emerg Med 2019 Mar;56(3):e23-e26

Date

01/30/2019

Pubmed ID

30691698

DOI

10.1016/j.jemermed.2018.12.035

Scopus ID

2-s2.0-85060457105   1 Citation

Abstract

BACKGROUND: Blastomycosis is caused by a fungus endemic to states and providences bordering the Lawrence Rivers and the Great Lakes. It can lead to significant pathology in both immunocompetent and immunocompromised hosts. This case report describes disseminated blastomycosis in an otherwise healthy 16-year-old patient.

CASE REPORT: A 16-year-old male presented with a chief complaint of flank pain. In the Emergency Department he described additional symptoms of emesis, cough, and weight loss. His vitals were appropriate; however, he had absent lung sounds in the left lower lung field, splenomegaly, a left thigh abscess, and lower-extremity edema. Imaging studies showed a left pleural effusion, mediastinal shift to the right, splenomegaly, a left psoas abscess, and undifferentiated bony involvement of L1 transverse process and the left 12th rib. Abscess cultures grew Blastomyces dermatitides. He was treated with amphotericin B, demonstrated clinical improvement, and was discharged on itraconazole. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The case fatality rate of blastomycosis is estimated at between 4.3% and 6.4%. Patients with solid organ transplant and associated immune suppression had a mortality of 33-38%. Given the nonspecific nature of this condition, a high level of suspicion is required for diagnosis, and early diagnosis is essential, as end organ damage in disseminated disease can include high-severity illness, including acute respiratory distress syndrome and central nervous system dysfunction. If any patient presents with symptomatology involving both skin and pulmonary systems, blastomycosis must be entertained as a possible diagnosis. Prompt diagnosis and treatment will significantly improve morbidity and mortality.

Author List

Teijido J, Drendel AL

Author

Amy L. Drendel DO Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Amphotericin B
Antifungal Agents
Blastomyces
Blastomycosis
Emergency Service, Hospital
Flank Pain
Humans
Immunocompromised Host
Itraconazole
Male
Pleural Effusion
Radiography, Thoracic
Splenomegaly
Vomiting
Wisconsin