title: Disseminated blastomycosis and acquired immunodeficiency syndrome: a case report and ultrastructural study.
abstract: A 42-year-old, African-American man presented with a 2-month history of weight loss and fever for 2 weeks. Presumptive diagnoses of human immunodeficiency virus infection (HIV) and acquired immunodeficiency syndrome were made on the basis of a CD4 lymphocyte count of 23 lymphocytes/mL. Chest x-ray revealed right paratracheal adenopathy and a miliary pattern. The etiology of the patient's pulmonary infection was not known, but tuberculosis was an important consideration. Over 5 days, the pulmonary infection progressed and was complicated by acute respiratory distress syndrome (ARDS), septic shock, and death, despite vigorous antibiotic and supportive therapy. Serologic tests for HIV infection were reported as positive after the patient's demise. The etiology of the patient's pulmonary infection, ARDS, and sepsis was not known until autopsy study revealed enumerable yeast-like cells of Blastomyces dermatitidis in the extensively consolidated lungs and in disseminated foci of infection in most other major organs. Diffuse alveolar damage was closely associated with the pulmonary blastomycosis. Electron microscopic study of the yeast-like cells of B. dermatitidis in the autopsy lung obtained and fixed 5 days after the patient's death revealed excellent preservation of viable organisms.
authors.affiliation: Pathology and Laboratory Medicine Service, Department of Veterans Affairs Medical Center, Washington, DC 20422, USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Guccion
authors.forename: P K
authors.initials: PK
authors.lastname: Rohatgi
authors.forename: N B
authors.initials: NB
authors.lastname: Saini
authors.forename: A
authors.initials: A
authors.lastname: French
authors.forename: S
authors.initials: S
authors.lastname: Tavaloki
authors.forename: S
authors.initials: S
authors.lastname: Barr
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000473:pathology*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000208:Acute Disease; D000328:Adult; D001344:Autopsy; D001759:Blastomycosis / Q000150:complications / Q000473:pathology*; D017809:Fatal Outcome; D006801:Humans; D008168:Lung / Q000473:pathology* / Q000648:ultrastructure*; D008172:Lung Diseases, Fungal / Q000150:complications / Q000473:pathology*; D008297:Male; D008854:Microscopy, Electron; D012128:Respiratory Distress Syndrome / Q000209:etiology