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      A rare case of Blastomyces dermatitidis brain abscess in an immunocompetent host

      case-report

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          Abstract

          Here we present a case of a 41-year old immunocompetent female from central Maryland, who presented with new onset seizures. Magnetic resonance imaging of brain revealed a solitary ring-enhancing lesion. Stereotactic brain biopsy confirmed Blastomyces dermatitidis brain abscess. Patient's clinical course was complicated by voriconazole-induced pancytopenia that prompted surgical resection and amphothericin-induced severe hypokalemia necessitating change to high dose fluconazole. Four months after surgical resection, patient remains in radiographic and clinical remission.

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          Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America.

          , P Pappas, Penny G Threlkeld … (2008)
          Evidence-based guidelines for the management of patients with blastomycosis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous management guidelines published in the April 2000 issue of Clinical Infectious Diseases. The guidelines are intended for use by health care providers who care for patients who have blastomycosis. Since 2000, several new antifungal agents have become available, and blastomycosis has been noted more frequently among immunosuppressed patients. New information, based on publications between 2000 and 2006, is incorporated in this guideline document, and recommendations for treating children with blastomycosis have been noted.
          Article 0 comments Cited 112 times – based on 0 reviews     Review now
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            Clinical and laboratory update on blastomycosis.

            Michael Saccente, Alisa Woods (2010)
            Blastomycosis is endemic in regions of North America that border the Great Lakes and the St. Lawrence River, as well as in the Mississippi River and Ohio River basins. Men are affected more often than women and children because men are more likely to participate in activities that put them at risk for exposure to Blastomyces dermatitidis. Human infection occurs when soil containing microfoci of mycelia is disturbed and airborne conidia are inhaled. If natural defenses in the alveoli fail to contain the infection, lymphohematogenous dissemination ensues. Normal host responses generate a characteristic pyogranulomatous reaction. The most common sites of clinical disease are the lung and skin; osseous, genitourinary, and central nervous system manifestations follow in decreasing order of frequency. Blastomycosis is one of the great mimickers in medicine; verrucous cutaneous blastomycosis resembles malignancy, and mass-like lung opacities due to B. dermatitidis often are confused with cancer. Blastomycosis may be clinically indistinguishable from tuberculosis. Diagnosis is based on culture and direct visualization of round, multinucleated yeast forms that produce daughter cells from a single broad-based bud. Although a long course of amphotericin B is usually curative, itraconazole is also highly effective and is the mainstay of therapy for most patients with blastomycosis.
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              Clinical Manifestations and Treatment of Blastomycosis

              Joseph McBride, Gregory M. Gauthier, Bruce S. Klein (2017)
              The causal agents of blastomycosis, Blastomyces dermatitidis and Blastomyces gilchristii, belong to a group of thermally dimorphic fungi that can infect healthy and immunocompromised individuals. Following inhalation of mycelial fragments and spores into the lungs, Blastomyces spp convert into pathogenic yeast and evade host immune defenses to cause pneumonia and disseminated disease. The clinical spectrum of pulmonary blastomycosis is diverse. The diagnosis of blastomycosis requires a high degree of clinical suspicion and involves culture-based and non-culture-based fungal diagnostic tests. The site and severity of infection, and the presence of underlying immunosuppression or pregnancy, influence the selection of antifungal therapy.
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                Author and article information

                Contributors
                James Doub
                Journal
                Journal ID (nlm-ta): Med Mycol Case Rep
                Journal ID (iso-abbrev): Med Mycol Case Rep
                Title: Medical Mycology Case Reports
                Publisher: Elsevier
                ISSN (Print): 2211-7539
                ISSN (Electronic): 2211-7539
                Publication date PMC-release: 10 March 2020
                Publication date Collection: June 2020
                Publication date (Electronic): 10 March 2020
                Volume: 28
                Pages: 8-11
                Affiliations
                [1]Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD, USA
                Author notes
                [∗ ]Corresponding author. 725 West Lombard Street, Baltimore, MD, 21201, USA. jdoub@ 123456ihv.umaryland.edu
                Article
                Publisher ID: S2211-7539(20)30015-4
                DOI: 10.1016/j.mmcr.2020.03.001
                PMC ID: 7090280
                PubMed ID: 32215246
                SO-VID: afbe8544-5451-4cef-a9a0-de2cf35f63b1
                Copyright © © 2020 The Author(s)
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 11 February 2020
                Date revision received : 3 March 2020
                Date accepted : 5 March 2020
                Categories
                Subject: Case Report

                Keywords: blastomyces dermatitidis,fungal brain abscess,dimorphic fungi,endemic mycoses,drug induced,pancytopenia,drug induced hypokalemia
                Data availability:
                Keywords: blastomyces dermatitidis, fungal brain abscess, dimorphic fungi, endemic mycoses, drug induced, pancytopenia, drug induced hypokalemia

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