Pulmonary alveolar proteinosis (PAP), in addition to acute generalized histoplasmosis, was found at autopsy of three adult males, 23, 51, and 52 years of age. All three patients became ill in the same region of Venezuela, south of Lake Maracaibo, an area considered highly endemic for histoplasmosis. The PAP may be due to an environmental factor.
Four patients are reported with mycotic pseudotumors of the breast. Two of the granulomas were due to involvement by histoplasmosis, one by blastomycosis, and one by cryptococcosis. In the three patients who were treated surgically, tumor was suspected preoperatively in two and an infected cyst in one. The fourth granuloma, that due to cryptococcosis, was unsuspected clinically and discovered at autopsy. Surgical excision was effective therapy in those so treated. A critical review of the literature revealed only one other previously published case (cryptococcic mastitis) of deep mycosis of the breast.The breast has rarely been reported as a site of fungal infection and, of the cases on record, only one is acceptable as deep mycosis.' However, since from one single laboratory four cases of mycotic mastitis were reported in a nine-year-period, the true incidence must be higher than recorded, and this differential diagnosis must be concidered in breast "tumors" that presently are looked for and detected more actively with the help of roentgenographic methods.
REPORT OF CASESCASE 1.-A cryptococcosis was found in both breasts of a young woman with a ten-month history of disseminated lupus erythematosus with nephritis and renal failure. She was treated with cortisone and dialyzed on several occasions. On autopsy, disseminated cryptococcosis was found in lungs, brain, meninges, liver, spleen, ovaries, and breast. Numerous cryptococci were seen in the breast tissue (Fig 1). A mild meningitis was observed across the cerebellum. As is frequently the case in cryptococcosis, no inflammatory response was seen in the other tissue (Table ).CASE 2.-A unilateral blastomycosis of the breast clinically ap pearing as an abscess was diagnosed preoperatively as (infected?) para-areolar cyst. After excision, drainage, and topical antifungal treatment, complete healing took place. Fungus cells with single
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