1/39. Laryngeal blastomycosis: a commonly missed diagnosis. Report of two cases and review of the literature.blastomycosis is a relatively uncommon fungal disease that most commonly affects the lungs. Other organs may be involved, usually secondary to dissemination of the organism. Laryngeal blastomycosis may occur in isolation from active pulmonary disease. The signs, symptoms, clinical features, and pathological findings of laryngeal blastomycosis mimic those of squamous cell carcinoma. Misdiagnosis may result in inappropriate treatment with potential morbidity. Proper understanding of the clinical presentation and familiarity with the histopathologic features of this disease are therefore imperative. In this paper, we report 2 cases of laryngeal blastomycosis, 1 of which was misdiagnosed as squamous cell carcinoma, clinically and microscopically, with consequent radiotherapy and laryngectomy. In the other case, a clinical diagnosis of glottic squamous cell carcinoma was rendered. However, blastomycosis was identified in a biopsy specimen. We also review cases of isolated laryngeal blastomycosis that have been reported in the English-language literature during the last 80 years. A number of those cases were misdiagnosed clinically and microscopically as squamous cell carcinoma.- - - - - - - - - - ranking = 1keywords = cell (Clic here for more details about this article) |
2/39. pleural effusion from blastomycetes in an adult Nigerian: a case report.A 37 year old hide and skin trader in Northern nigeria, presented with massive right sided purulent pleural effusion. This started with cough, chest pain and fever for 5 weeks following endotracheal intubation. He had chest tube inserted and was treated with antituberculous drugs for 10 weeks without improvement. Fungal studies on the sputum, and pleural fluid yielded Blastomycetes dermatitidis which responded excellently to ketoconazole and saline pleural lavage. This experience underscores the need for early suspicion of systemic mycosis in suspected cases of tuberculosis with poor or no response to treatment. This will reduce morbidity, mortality and cost of treatment.- - - - - - - - - - ranking = 0.25keywords = cell (Clic here for more details about this article) |
3/39. Sweet's syndrome-like blastomycosis.Cutaneous North American blastomycosis is characterized clinically by verrucous nodules and histologically by pseudoepitheliomatous hyperplasia, intraepidermal neutrophilic microabscesses, and a dermal mixed inflammatory cell infiltrate containing giant cells. We describe a patient who presented clinically with erythematous nodules and plaques on the lower extremities characterized histologically by a diffuse neutrophilic infiltrate, with lack of epidermal hyperplasia. The lesions were clinically and histologically reminiscent of Sweets syndrome. On close microscopic inspection scattered histiocytes and multinucleated giant cells were present in the dermis, and fungal stains demonstrated budding yeast forms consistent with blastomyces sp.- - - - - - - - - - ranking = 0.75keywords = cell (Clic here for more details about this article) |
4/39. Cutaneous blastomycosis.We report on a patient with cutaneous blastomycosis and no evidence of systemic involvement. This diagnosis was made on the basis of clinical findings and confirmed by histologic examination and results of culture. The primary lesion in blastomycosis is almost always pulmonary. However, occasionally, as in our patient, the pulmonic focus resolves spontaneously before the patient presents. Disseminated lesions occur most often in the skin, followed by bone, genitourinary tract, and central nervous system. Our patient had an excellent response to ketoconazole without adverse effects.- - - - - - - - - - ranking = 0.25keywords = cell (Clic here for more details about this article) |
5/39. Cutaneous blastomycosis presenting as non-healing ulcer and responding to oral ketoconazole.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.- - - - - - - - - - ranking = 0.25keywords = cell (Clic here for more details about this article) |
6/39. blastomycosis of the eyelid and conjunctiva.A 37-year-old man with a recurrent papillomatous lesion of the upper eyelid and four separate bulbar conjunctival ulcers was found to have North American blastomycosis. This represents the first reported case with conjunctival lesions that were not simply contiguous with eyelid involvement. This case underscores the importance of considering blastomycosis in the differential diagnosis of granulomatous conjunctivitis and when examining a lesion of the eyelid resembling a squamous cell carcinoma or atypical papilloma.- - - - - - - - - - ranking = 0.25keywords = cell (Clic here for more details about this article) |
7/39. Mystery in the basement.56 year-old male presented to the University of mississippi Medical Center emergency department (ED) with complaints of progressive shortness of breath, productive cough, fever, and malaise. His past medical history was significant for hypertension as well as a 60 pack-year history of smoking. Upon arrival to the ED he had a temperature of 103.6 degrees F, blood pressure of 80/40 mm Hg, a pulse of 110 beats per minute, respirations of 28 per minute, and an oxygen saturation of 50% on room air. He appeared to be in significant respiratory distress. lung examination revealed diffuse bilateral rhonchi and wheezes in all lung fields. He was emergently intubated. Chest radiograph demonstrated a miliary pattern scattered throughout all lung fields in addition to parenchymal opacities. A complete blood count revealed a white blood cell count of 33,500 10(3)/microL, hematocrit of 37%, and platelets of 906,000 10(3)/uL. blood urea nitrogen and creatinine were 27 mg/dL and 1.0 mg/dL, respectively. Initial ABG on 100% oxygen showed pH 7.15, pCO2 82 mm Hg, and pO2 62 mm Hg. troponin i was negative. An electrocardiogram demonstrated sinus tachycardia. Blood and urine cultures were obtained.- - - - - - - - - - ranking = 0.25keywords = cell (Clic here for more details about this article) |
8/39. Secondary intracerebral blastomycosis with giant yeast forms.Secondary central nervous system (CNS) blastomycosis is an unusual manifestation of blastomycosis. We report a case of recurrent intracerebral blastomycosis that presented histopathologically with giant yeast-like cells and multinucleation that mimicked coccidioides immitis. The yeast forms of blastomyces dermatitidis usually range in size from 8 to 20 microm in diameter. Large or giant yeast forms (20-40 microm) are rare. The four cases previously reported in the literature involving giant yeast cell forms of B. dermatitidis are reviewed here. Intracerebral blastomycosis should be suspected in patients with signs and symptoms of CNS lesions and histories of primary blastomycosis, or treatment with corticosteroids, or comprised immune systems. The diagnosis should be confirmed by culture which presents typical biphasic microbiologic features.- - - - - - - - - - ranking = 0.5keywords = cell (Clic here for more details about this article) |
9/39. Two cases of blastomycosis from a common source: use of dna restriction analysis to identify strains.Two friends, one with AIDS, developed severe pulmonary blastomycosis but differed markedly in clinical course. The human immunodeficiency virus-negative patient responded completely to ketoconazole; the patient with AIDS died of progressive disseminated infection despite treatment with fluconazole and amphotericin b. Epidemiologic investigation suggested a common source of infection, but serologic evaluation and environmental cultures were unrevealing. EcoRI digestion of the blastomyces dermatitidis isolates showed identical restriction fragment patterns that differed from patterns obtained from other clinical isolates. Analysis using a histoplasma capsulatum ribosomal dna probe that cross-hybridizes with B. dermatitidis showed that the isolates from the two patients were identical and different from others. Thus, the patients were probably infected with the same strain, possibly from a common source. These data indicate the critical role of cellular immunity in patients with blastomycosis, show that there are multiple genotypes of B. dermatitidis, and suggest that dna restriction analysis is a useful epidemiologic tool.- - - - - - - - - - ranking = 0.25keywords = cell (Clic here for more details about this article) |
10/39. blastomycosis in a South Indian patient after visiting an endemic area in USA.We describe a case of blastomycosis in a diabetic patient from South india who had visited Milwaukee, wisconsin, an endemic area for blastomycosis in the USA. After his return to Bangalore, india, the patient developed intermittent fever of moderate to high grade, cough, loss of weight and appetite, and abscesses in the left cubital fossa and thigh regions. Systemic examination at our hospital revealed that he had dullness to percussion over the chest region and decreased breath sounds. Direct examination of Gram-stained smears of the pus from an abscess showed many broad-based budding yeast cells and culture yielded a dimorphic fungus later identified as blastomyces dermatitidis. Histologic examination of the curettage tissue slides stained with hematoxylin and eosin, periodic acid Schiff's reagent, and Gomori's methenamine silver stain procedures showed many broad-based budding cells characteristic of B. dermatitidis. The patient was successfully treated, initially with amphotericin b, followed by oral itraconazole for a period of 6 months. blastomycosis cases in india are reviewed and the likely source of infection in this patient is discussed.- - - - - - - - - - ranking = 0.5keywords = cell (Clic here for more details about this article) |
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