Chest Infections |

Have a Blast… in Structurally Abnormal Lung! FREE TO VIEW

Vinod Khatri, MD; Krishna Khatri, MD; Jose Paul, MD; Salman Alim, MD
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Rosalind Franklin University of Medicine and Science, North Chicago, IL

Chest. 2013;144(4_MeetingAbstracts):190A. doi:10.1378/chest.1704975
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SESSION TITLE: Infectious Disease Case Report Posters III

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Fungal infections typically seen in the setting of structurally abnormal lung are histoplasma and aspergillus and a pre-existing structurally abnormal lung is not a typical risk factors for pulmonary blastomycosis.

CASE PRESENTATION: 56 yr old AA male, chronic smoker from southern Wisconsin was admitted with complaints of shortness of breath, cough for 3 weeks. The was associated with yellowish green sputum and he also reported low grade fever and a 20 pound weight loss during the same duration. He was treated with a course of levofloxacin two weeks back for community acquired pneumonia. He worked as clerk, reported no sick contacts or recent travel, had no history of exposure to pets and has a single heterosexual partner. On examination he was is in no acute distress, his vital signs were temp- 99 F, P-86/min, BP 128/74, RR-18/min and SpO2-98% on room air. His chest exam revealed signs of consolidation in left upper lobe. A CT scan of chest revealed a dense infiltrate in left upper lobe with a background of marked emphysematous changes in bilateral upper lobes, which were also present on a previous CT done 5 years back. Patient underwent a flexible bronchoscopy and bronchoalveolar lavage and was found to have blastomyces on culture from bronchoalveolar lavage samples. When enquired about any potential environmental exposure, in the retrospect he reported recent excavation activity near his house. He was subsequently stated on itraconazole.

DISCUSSION: North America is the “home” of three of the major endemic mycoses apart from other less common forms of mycoses. Pulmonary manifestations are common in these and structurally abnormal lung serve as ideal dwelling sites for fungi such as histoplasma and aspergillus. For sporadic cases of pulmonary blastomycosis, residence close to water in a highly endemic area and recent excavation activity are the typical risk factors and a pre-existing structural abnormal lung is not described as a risk factor in literature. This case highlights that blastomyces may also have an affinity for structurally abnormal lung.

CONCLUSIONS: Blastomyces should be also considered in the differential diagnoses of pulmonary mycoses in patients with structurally abnormal lungs, especially in endemic areas.

Reference #1: Goodwin RA Jr, Owens FT, Snell JD, et al: Chronic pulmonary histoplasmosis. Medicine (Baltimore) 55:413-452, 1976.

Reference #2: Denning DW: Chronic forms of pulmonary aspergillosis. Clin Microbiol Infect 7(Suppl 2):25-31, 2001.

Reference #3: Baumgardner DJ, Brockman K: Epidemiology of human blastomycosis in Vilas County, Wisconsin. II: 1991-1996. WMJ 97:44-47, 1998.

DISCLOSURE: The following authors have nothing to disclose: Vinod Khatri, Krishna Khatri, Jose Paul, Salman Alim

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