ABSTRACT
TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: Blastomycosis is endemic to the midwest, south-central and southeast regions of North America. It should thus be suspected in the differential of patients presenting with atypical symptoms, as extrapulmonary manifestations can be seen. We present a case of disseminated blastomycosis to the spine prior to development of significant pulmonary symptoms. CASE PRESENTATION: 38 year old male presents to a tertiary center in Southern Indiana with back pain of 8 months, fever and dyspnea. Magnetic resonance imaging was significant for L1 osteitis and chest x-ray showed diffuse interstitial markings. Lab work showed leukocytosis with erythrocyte sedimentation rate of 91, and C-reactive protein of 45. He was initiated on broad spectrum antibiotics without any improvement. Due to worsening respiratory failure requiring supplemental oxygen, infectious disease and pulmonology specialists ruled out Legionella, Aspergillosis, COVID-19, HIV, Histoplasmosis, Mycoplasma, Hantavirus and Tuberculosis. Blood cultures and respiratory panel were negative. Urinary blastomycosis antigen was positive. Patient completed 14 days of amphotericin B and was discharged on itraconazole for at least 1 year. DISCUSSION: Blastomycosis can have a broad spectrum of manifestations with pulmonary infection in more than 79% of patients. Extrapulmonary dissemination is less common though can occur in approximately 25-40% of symptomatic patients. Osseous blastomycosis is the second most common dissemination site following the skin and is seen in approximately 5-25% of patients. CONCLUSIONS: We recommend early consideration of blastomycosis in patients with atypical infectious symptoms who reside in Blastomyces endemic regions. Early diagnosis is key in initiating appropriate treatment and preventing severe complications of disseminated disease. DISCLOSURE: Nothing to declare. KEYWORD: blastomycosis