University of Wisconsin–Madison Medical College of Wisconsin

An Unusual Presentation of Blastomycosis 

Ryan Lokkesmoe, MD; Acacia Dishman, MD, PhD; John C. Feemster, MD; Daniel McKee, MD; Pinky Jha, MD

WMJ. 2023;122(4):290-293.

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Introduction: Blastomycosis is a rare pyogranulomatous infection that most commonly involves the lungs and sometimes the skin. Other manifestations are much less common. Diagnosis relies on biopsy, histopathology, and culture of suspicious lesions.

Case Presentation: In this case, a healthy 42-year-old male from Wisconsin presented to the emergency department with a chief complaint of 2 weeks of knee pain without a clear mechanism of injury. Upon further examination, he was found to have lesions on his abdomen, which he had first noticed over 3 years prior and had been treated with antibiotics as cellulitis for nearly 18 months. Biopsy of these lesions was consistent with blastomycosis infection, and further work-up and examination was notable for brain and laryngeal lesions without any pulmonary involvement. Intense anti-fungal treatment was immediately initiated with dramatic improvement in his symptoms.

Discussion: This case highlights the importance of a thorough physical exam and consideration of rare infections in cases without clear answers. To our knowledge, this is the first published example of a blastomycosis infection involving brain, laryngeal, skin, and knee lesions without pulmonary infection.

Author Affiliations: Medical College of Wisconsin, Department of Medicine, Milwaukee, Wisconsin (Lokkesmoe, Dishman, Feemster, McKee, Jha).
Corresponding Author: Ryan Lokkesmoe, MD, 2403 S 81st St, West Allis, WI 53219; email; ORCID ID 0009-0002-3609-9893
Acknowledgements: The authors thank Travis Suss (TS), PharmD, BCGP, and Tim Hartman (TH), PharmD, BCPS, CPHIMS, for their assistance in survey data analysis.
Funding/Support: None declared.
Financial Disclosures: None declared.
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