22 April 2023
: Case report 
Classical Presentation of Disseminated Blastomycosis in a 44-Year-Old Healthy Man 3 Months After Diagnosis of COVID-19
Challenging differential diagnosis, Rare disease
Diana Fan1ABDEF, Ali Ahmad
1ABDE, Jared Frisby2DEF, Kavita Darji3BE, Ashley Ojeaga3BE, Ramona Behshad3BE, M. Yadira Hurley3BE, Mallory Abate3BE, Paul Kunnath1AE*
DOI: 10.12659/AJCR.938659
Am J Case Rep 2023; 24:e938659
Table 2. A full account of the microbiology results from a 44-year-old man with a diagnosis of blastomycosis. Results are reported as either positive/abnormal/growth results or negative/normal/no growth results. Identification of microorganisms in growth results is reported when applicable.
| Positive/abnormal/growth results | Negative/normal/no growth results | |
|---|---|---|
| Blood | -- | Cultures no growth day 5 |
| -- | Fungal culture – no fungus isolated | |
| -- | AFB culture – no acid-fast bacillus isolated | |
| Urine | Blastomyces antigen >200 U/mL | Legionella antigen |
| Blastomyces Dermatitidis EIA (enzyme immunoassay) – Detected | Chlamydia + Gonococcal amplified probe | |
| Skin (lesion bx) | Fungus smear/culture – light growth | Gram stain – no polymorphonuclear cells. No organisms seen |
| Blastomyces dermatitidis | Culture – no growth | |
| Fungus Identification – Blastomyces dermatitidis | AFB smear – no acid-fast bacilli seen | |
| -- | AFB* culture – no acid-fast bacillus isolated | |
| Sputum | -- | Culture – moderate normal oropharyngeal flora |
| -- | Gram stain:<10 per low power field squamous epithelial cells≥25 per lpf polymorphonuclear cellsLight gram-negative bacilliLight gram-positive cocciRare gram-positive bacilli | |
| -- | AFB culture – no acid-fast bacillus isolated | |
| -- | AFB smear – no acid-fast bacilli seen | |
| -- | Fungal culture – no fungus isolated | |
| -- | Fungus stain – no yeast or hyphae seen. No | |
| Cyst fluid | -- | Culture – no growth |
| -- | Gram stain – moderate polymorphonuclear cells. No organisms seen. | |
| BAL | Fungal culture – light Blastomyces dermatitidis | AFB culture, AFB smear |
| Fungus stain – no yeast or hyphae seen. No | Gram culture, gram stain | |
| Fungus identification – Blastomyces | ||
| Bronchial washings | Fungal culture – light mold | AFB* culture, AFB smear |
| -- | Fungus stain – no yeast or hyphae seen. No | |
| Lung biopsy | Fungal culture – rare mold | AFB culture, smear |
| -- | Fungus stain – no yeast or hyphae seen. No | |
| Feces | -- | Ova and parasite fecal interpretation – negative |
| AFP – acid-fast bacilli. | ||