Pustular blastomycosis

Fatal blastomycosis after exogenous immunosuppression in a healthy gardener

“… 4 , 5 Atypical cutaneous blastomycoses lesions, such as pustular and pyoderma gangrenosum–like ulcerative lesions, have also been reported. 6 , 7 …”

Hemorrhagic pustules in an Aboriginal man

“…5 Retrospective observational studies suggest that, in most individuals, the respiratory tract is the primary site of disease, and the clinical presentation may be acute, subacute or chronic. [4][5][6][7][8] Several epidemiologic surveys have confirmed that disseminated disease, which may occur concurrently or subsequently to respiratory disease, occurs in 25%-30% of symptomatic individuals. [4][5][6] Disseminated disease most commonly involves (in order of frequency) the skin, bone, the genitourinary tract and the central nervous system.…”

“…[4][5][6] Disseminated disease most commonly involves (in order of frequency) the skin, bone, the genitourinary tract and the central nervous system. 4,5,8 Skin involvement occurs in 40%-80% of cases of disseminated blastomycosis. Presentation is typically one or a few papulopustular or verrucous lesions (so-called papulopustular cutaneous blastomycosis) or one or few ulcerated lesions (so-called ulcerative cutaneous blastomycosis).…”

“…The purulent and vesicular lesions appeared in crops, which is more characteristic of varicella-zoster virus infection, 3 and constitutes a rare form of disseminated cutaneous blastomycosis (only seven reported cases). [8][9][10][11][12] Most reported cases of pustular blastomycosis (five of seven cases) occurred in Tennessee, where it has been postulated that a genetic variant of B. dermatitidis may be the cause of this unusual form of the disease. 8 In our patient, the use of warfarin and his high INR likely contributed to the hemorrhagic appearance of what may have initially been pustular lesions.…”

“…[8][9][10][11][12] Most reported cases of pustular blastomycosis (five of seven cases) occurred in Tennessee, where it has been postulated that a genetic variant of B. dermatitidis may be the cause of this unusual form of the disease. 8 In our patient, the use of warfarin and his high INR likely contributed to the hemorrhagic appearance of what may have initially been pustular lesions. The hemorrhagic nature of these disseminated lesions in an older patient also raised the possibility of encapsulated bacterial pathogens, such as Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae.…”