Tuberc Respir Dis.  2012 Jan;72(1):77-81.

A Case of Pulmonary Blastomycosis Mimicking Pulmonary Tuberculosis

• Jhun BW
• Kim DM
• Park JH
• Yoo HS
• Shim H
• Kim JG
• Han J
• Kwon OJ

Abstract

Blastomyces dermatitidis is a dimorphic fungus that causes the systemic pyogranulomatous disease known as blastomycosis. Blastomycosis most often involves the lungs, skin, and may involve nearly every organ in the body. It is difficult, however, to diagnose blastomycosis in the early stage of pulmonary disease because clinical manifestations are varied from subclinical infection to acute respiratory distress syndrome. Since blastomycosis is often accompanied by granulomatous inflammation in histopathologic findings, differentiation from other etiologic diseases is important. We report a case of a 45-year-old male with pulmonary blastomycosis who had been misdiagnosed with tuberculosis for 3 months.

Keyword

Blastomycosis; Granuloma; Tuberculosis

MeSH Terms

Asymptomatic Infections
Blastomyces
Blastomycosis
Fungi
Granuloma
Humans
Inflammation
Lung
Lung Diseases
Male
Middle Aged
Respiratory Distress Syndrome, Adult
Skin
Tuberculosis
Tuberculosis, Pulmonary

Figure

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  Figure 1 Posteroanterior chest radiograph showed air-space consolidation with irregular margin in the right upper lung zone.

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  Figure 2 (A) Chest computed tomography revealed a low attenuation lesion communicating with the right anterior chest wall, suggestive of empyema necessitatis formation. (B) In the right kidney area a 5 cm size wedge shaped low attenuated lesion was observed.

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  Figure 3 Microscopic findings of video-assisted thoracopscopic surgery biopsy showed granulomatous inflammation with a multinucleated giant cell (hematoxylin and eosin stain, ×400).

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  Figure 4 (A) Yeast form fungal organisms with a thick cell wall and a single broad-based bud were stained with Gomori methenamine silver stain (Gomori methenamine silver stain, ×400). (B) No highlighting organism was identified with mucicarmine stain (Mucicarmine, ×400).

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  Figure 5 Posteroanterior chest radiograph indicated an improved consolidative lesion in the right lung zone after right upper lobectomy and 2 months of itraconazole treatment.

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