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.
Day | Events |
---|---|
0 | Developed symptoms: cough, headache, congestion, hemoptysis |
3 | Visit 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 |
85 | Developed papulopustular rash |
92 | Presenting 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 | |
93 | Imaging 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 |
97 | Bronchoscopy done with pulmonology, showing erythematous airways in left upper lobe and yellow-tinged secretions |
98 | Blastomyces Dermatitidis antigen detected. Began IV liposomal amphotericin B treatment |
MRI with contrast showing multiple supratentorial and infratentorial enhancing lesions, concerning for septic emboli | |
122 | Nephrology 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 |
123 | Repeat imaging showing significant decrease in the size & number of enhancing brain lesionsInterval improved aeration of bilateral upper lobes with residual consolidation |
125 | Discharged after completion of IV amphotericin B with a plan to continue oral Itraconazole for 12 monthsBaseline Creatinine 1.0→1.6 at discharge |
173 | Follow up with pulmonology with improvement of symptoms – cough has resolved. No neurologic symptoms.Dermatologic lesions improved |
193 | Follow up with nephrology. No urinary symptoms. Creatinine 1.4 from 1.6 at discharge |