Blastomycosis. Report of a case with noninvasive, rapid diagnosis of dermal lesions by the Papanicolaou technique.

BACKGROUND: Blastomycosis is a rare fungal infection that occurs most often in young to middle-aged men. A common route of infection is through continued contact with soil, occurring in such occupations as gardening and construction work. The skin and lungs are primarily affected. When the respiratory system is involved, blastomycosis may be misdiagnosed as pulmonary miliary tuberculosis. CASE: A 54-year-old, African American male presented with dry cough and multiple verrucous skin lesions affecting the face, shoulder and legs. Chest roentgenography indicated bilateral lung involvement. The patient died following a short, difficult hospital course. Autopsy revealed verrucous skin lesions with dry, thick, raised margins and central necrosis and umbilication, and severe, diffuse pulmonary involvement clinically and radiologically, resembling miliary tuberculosis. A smear from a leg ulcer stained by the Papanicolaou technique revealed fungi within the giant cells. CONCLUSION: Clinical and radiologic findings alone do not establish the diagnosis of blastomycosis. Respiratory involvement may lead to a misdiagnosis of pulmonary miliary tuberculosis. Sputum and bronchial washing examinations by a laboratory technique are in order. This case indicates that cytologic examination of the exudate from an ulcer may result in a strongly suggestive diagnosis.

Prevalence of myocardial ischemia as depicted by regional wall motion abnormality in blacks.

Coronary artery disease with subsequent myocardial ischemia is a common cause of morbidity and mortality in the United States, and data are scarce on the prevalence of the disease in blacks. Regional wall motion abnormality correlates either directly or indirectly with myocardial ischemia. This study examines the two-dimensional (2-D) echocardiography of patients > or = 45 years for men and > or = 55 years at Metropolitan Nashville General Hospital, Nashville, Tennessee. A total of 601 2-D echocardiographic studies were performed on patients who presented with symptoms and signs of cardiovascular disease. Of these, 377 (62.7%) met the age criteria and formed the study group; 92 were excluded for various reasons, leaving 285 (75%) in the analysis group. A total of 80 (28.1%) patients had regional wall motion abnormality while 205 (71.9%) did not. On analysis of the 80 patients with regional wall motion abnormality, the segment of the heart commonly affected was the septal area, although more than one segment of the myocardium was affected in all of the patients. A total of 36 (45%) patients had normal left ventricular size. In relation to race, blacks had a higher prevalence of regional wall motion abnormality compared with whites (29.2% versus 26.2%, respectively), but the difference was not statistically significant. These prevalence rates indicate the importance of looking for this abnormality during echocardiographic evaluation of a patient. The presence of regional wall motion abnormality on 2-D echocardiography in the presence of other cardiovascular risk factors necessitates further investigation and management to minimize later complications of coronary artery disease.

Epidemiology of symptomatic mitral valve prolapse in black patients.

This study analyzed the charts of 743 black patients who visited the emergency rom of a Nashville Hospital with symptoms of chest pain, palpitation, or fatigue. One hundred sixty-five met the criteria for the diagnosis of mitral valve prolapse (MVP). Epidemiologic factors of symptomatic MVP in blacks (ie, symptoms reported based on age and sex) were examined to determine whether there are significant differences in the prevalence of symptomatic MVP with relation to black males and females. Similarities were found in the patterns of the ages of both males and females and the symptoms that were reported. No significant differences were found between black males and females, which does not support previous findings.