Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

22 April 2023: Articles

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 Fan A , Ali Ahmad A , Jared Frisby D , Kavita Darji B , Ashley Ojeaga B , Ramona Behshad B , M. Yadira Hurley B , Mallory Abate B , Paul Kunnath A*

DOI: 10.12659/AJCR.938659

Am J Case Rep 2023; 24:e938659

Table 3. A comprehensive account of events from the entire disease course of a 44-year-old male with a diagnosis of blastomycosis, as described in this case report. Day 0 is marked as symptom onset. Following events are listed in chronological order according to days since symptom onset.

DayEvents
0Developed symptoms: cough, headache, congestion, hemoptysis
3Visit to primary care provider, where he tested positive for COVID-19. Started on Doxycycline 100mg BID for 7 days.CT at this time showed L upper lobe mass indeterminate for malignancy vs rounded bacterial pneumonia
85Developed papulopustular rash
92Presenting symptoms to our ED: persistent cough and rash
Outpatient CT showing:   Substantial progression of consolidation/atelectasis and peripheral peribronchial thickening and nodularity in the left upper lobe and lingula since 10/21/21. Within the area of consolidation are increasing air collections suggesting lung necrosis  New infiltrate & atelectasis in the right upper lobe and left lower lobe. Focal bronchial dilation vs early developing cavitary nodules
93Imaging showing consolidative opacities in bilateral upper lobes concerning for multifocal necrotizing pneumonia and multifocal nodules within the subcutaneous fat, with some contacting the skin surface correlating with patient’s rash
97Bronchoscopy done with pulmonology, showing erythematous airways in left upper lobe and yellow-tinged secretions
98Blastomyces Dermatitidis antigen detected. Began IV liposomal amphotericin B treatment
MRI with contrast showing multiple supratentorial and infratentorial enhancing lesions, concerning for septic emboli
122Nephrology consulted for developing acute kidney injury secondary to amphotericin B administrationKidney ultrasound showing normal renal size with no evidence of nephrolithiasis, hydronephrosis, or renal mass
123Repeat imaging showing significant decrease in the size & number of enhancing brain lesionsInterval improved aeration of bilateral upper lobes with residual consolidation
125Discharged after completion of IV amphotericin B with a plan to continue oral Itraconazole for 12 monthsBaseline Creatinine 1.0→1.6 at discharge
173Follow up with pulmonology with improvement of symptoms – cough has resolved. No neurologic symptoms.Dermatologic lesions improved
193Follow up with nephrology. No urinary symptoms. Creatinine 1.4 from 1.6 at discharge

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923