Pulmonary Blastomycosis: A case series and review of unique radiological findings

Maini, Ruby; Ranjha, Suhayb; Tandan, Nitin; Regmi, Manjari; Ullah, Saad; Stone, Taylor; Nayeemuddin, Faraaz; Pervin, Najwa

doi:10.1016/j.mmcr.2020.03.006

Cited by 7 publications

(7 citation statements)

References 13 publications

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“…Less commonly, patients present with (or progress to) an acute form of pulmonary infection. In its acute form, pulmonary blastomycosis presentations can range in severity from subclinical pneumonia to acute respiratory distress syndrome (ARDS) [ 9 , 47 , 50 ]. Typical symptoms include fever, night sweats, dyspnea, cough (productive or non-productive), hemoptysis, fatigue, malaise, anorexia, and weight loss, often leading to an initial misdiagnosis of bacterial pneumonia [ 10 , 48 , 49 ].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…The most common presentation on chest imaging is airspace consolidation, most often described as patchy opacities. Less commonly, in fulminant pulmonary blastomycosis, large and/or bilateral consolidations can be found [ 10 , 50 , 51 ]. Other less common radiographic findings include mass-like lesions [ 52 , 53 ], granulomatous or cavitary lesions similar to tuberculosis [ 54 , 55 ], nodules [ 10 , 51 ], diffuse interstitial “tree-in-bud” nodularities, or, rarely, miliary disease with endobronchial extension.…”

Section: Clinical Presentationmentioning

confidence: 99%

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Blastomycosis—Some Progress but Still Much to Learn

Pullen

Alpern

Bahr

2022

JoF

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Blastomycosis, caused by Blastomyces spp., is an endemic mycosis capable of causing significant disease throughout the body. Higher rates of infection are seen in the Mississippi and Ohio River valleys, the Great Lakes region of the United States and Canada, much of Africa, and, to a lesser extent, in India and the Middle East. Limited reporting inhibits our true understanding of the geographic distribution of blastomycosis. An estimated 50% of those infected remain asymptomatic. Of those who present with symptomatic disease, pulmonary involvement is most common, while the most common extrapulmonary sites are the skin, bones, genitourinary system, and central nervous system. Itraconazole is the standard therapy for mild–moderate disease. Data for other azoles are limited. Amphotericin is used for severe disease, and corticosteroids are occasionally used in severe disease, but evidence for this practice is limited. Despite increasing incidence and geographic reach in recent years, there are still significant knowledge gaps in our understanding of blastomycosis. Here, we provide an updated review of the epidemiology, clinical presentations, and diagnostic and therapeutic approaches for this infection. We also discuss areas needing further research.

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Section: Clinical Presentationmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Blastomycosis—Some Progress but Still Much to Learn

Pullen

Alpern

Bahr

2022

JoF

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“…Associated skin lesions are important clues to the diagnosis as in histoplasmosis. 48,69 The differential diagnosis from other fungal infections and tuberculosis may be difficult, when only imaging studies are evaluated in isolation. However, blastomycosis should be considered in patients with skin lesions and laboratory tests negative for tuberculosis and aspergillosis and also if the patient hails from or has visited an endemic area.…”

Section: Histoplasmosismentioning

confidence: 99%

“…In a few reported cases, the condition has come to light only at surgical resection for a suspected malignancy. 48,69 Treatment: Itraconazole is typically used to treat mild-tomoderate blastomycosis, while amphotericin B is usually recommended for severe pulmonary blastomycosis. 48,69 Viral Infections…”

Section: Histoplasmosismentioning

confidence: 99%

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Imaging Approach to Pulmonary Infections in the Immunocompromised Patient

Grover

Antil

et al. 2022

Indian J Radiol Imaging

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Pulmonary infections are the major cause of morbidity and mortality in immunocompromised patients and almost one-third of intensive care unit patients with pulmonary infections belong to the immunocompromised category. Multiple organisms may simultaneously infect an immunocompromised patient and the overwhelming burden of mixed infections further predisposes critically ill patients to acute hypoxemic respiratory failure. Notwithstanding that lung ultrasound is coming into vogue, the primary imaging investigation is a chest radiograph, followed by thoracic CT scan. This review based on our experience at tertiary care teaching hospitals provides insights into the spectrum of imaging features of various pulmonary infections occurring in immunocompromised patients. This review is unique as, firstly, the imaging spectrum described by us is categorized on basis of the etiological infective agent, comprehensively and emphatically correlated with the clinical setting of the patient. Secondly, a characteristic imaging pattern is emphasized in the clinical setting-imaging-pattern conglomerate, to highlight the most likely diagnosis possible in such a combination. Thirdly, the simulating conditions for a relevant differential diagnosis are discussed in each section. Fourthly, not only are the specific diagnostic and tissue sampling techniques for confirmation of the suspected etiological agent described, but the recommended pharmaco-therapeutic agents are also enumerated, so as to provide a more robust insight to the radiologist. Last but not the least, we summarize and conclude with a diagnostic algorithm, derived by us from the characteristic illustrative cases. The proposed algorithm, illustrated as a flowchart, emphasizes a diagnostic imaging approach comprising: correlation of the imaging pattern with clinical setting and with associated abnormalities in the thorax and in other organs/systems, which is comprehensively analyzed in arriving at the most likely diagnosis. Since a rapid evaluation and emergent management of such patients is of pressing concern not only to the radiologist, but also for the general physicians, pulmonologists, critical care specialists, oncologists and transplant surgery teams, we believe our review is very informative to a wide spectrum reader audience.

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Endobronchial blastomycoses: A rare pathogen in a unique location

Springsted

Kollipara

Giri

2021

Respiratory Medicine Case Reports

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A middle-aged woman from Southwest Virginia presented to pulmonary clinic with 4 months of dry cough. Further imaging with Computed Tomography (CT) of the chest showed an infiltrative lung mass. The patient underwent bronchoscopy that showed an endobronchial lesion on right and left main stem bronchi. Endobronchial biopsy of the lesion showed acute and chronic granulomatous inflammation and tissue cultures grew Blastomycoses dermatitides. We hereby present a rare case of endobronchial blastomycoses with pulmonary infiltrates presenting as chronic cough.

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Pulmonary Blastomycosis: A case series and review of unique radiological findings

Cited by 7 publications

References 13 publications

Blastomycosis—Some Progress but Still Much to Learn

Blastomycosis—Some Progress but Still Much to Learn

Imaging Approach to Pulmonary Infections in the Immunocompromised Patient

Endobronchial blastomycoses: A rare pathogen in a unique location

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