Blastomycosis: a case report and review of the literature.
BACKGROUND
Blastomycosis is a chronic granulomatous and suppurative mycosis caused by the fungus Blastomyces dermatitidis. This is a dimorphic fungus, which exists as a non-pathogenic mold in mycelial form in nature and converts to pathogenic yeast at body temperature. Infection is acquired by either inhalation or inoculation. We report a case of blastomycosis with severe involvement of the scalp, face, and neck, with no evidence of systemic involvement.


METHODS
Biopsy specimen was stained with hematoxylin and eosin, periodic acid-Schiff (PAS), PAS with diastase digestion, and Grocott. Culture was performed on a Sabouraud's dextrose agar plate using an aseptic technique as per standard operating procedure for processing mycology specimens at our institution. A lactophenol cotton blue preparation from the cultured material was performed.


RESULTS
Histopathologic examination showed pseudoepitheliomatous hyperplasia and a granulomatous inflammation with round to oval organisms, with refractile cell walls in the cytoplasm of giant cells. PAS, PAS with diastase digestion, and Grocott stains enhanced the organisms. Cultured material showed growth after 10 days, and the lactophenol cotton blue preparation from the cultured material showed the organism to be Blastomyces dermatitidis. Sensitivity studies favored treatment with itraconazole. Radiological examination of the patient showed no evidence of systemic involvement.


CONCLUSIONS
Our case may represent the rare primary cutaneous inoculation blastomycosis as lesions started on an area of previous trauma. Treatment with itraconazole was successful.
Department of Dermatology, University of Limpopo (Medunsa Campus), Medunsa, South Africa. motswaledi1@webmail.co.za
Hendrick M
HM
Motswaledi
Francinah M
FM
Monyemangene
Bonnie R
BR
Maloba
Dick L
DL
Nemutavhanani
D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use; D001758:Blastomyces; D001759:Blastomycosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D005148:Facial Dermatoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D009333:Neck / Q000382:microbiology; D012536:Scalp Dermatoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology
D000935:Antifungal Agents; D017964:Itraconazole