Abstract
Blastomycosis is a fungal disease caused by Blastomyces, most typically affecting the lungs but also occasionally the bone, skin, and central nervous system. Unlike other fungal infections, blastomycosis can normally present in immunocompetent patients, including in its disseminated form. Here we report a case of a 42-year-old white female who presented to the clinic with multiple erythematous plaques on the extremities with central ulcerations which appeared 3 months prior. Around the same time she had also developed chest pain with right upper lobe consolidation on chest imaging read as possible atypical infection. She had no significant travel or exposure history or history of immunosuppression. Initial biopsies showed yeast forms consistent with Blastomycosis, and the patient was started on itraconazole. Culture grew Blastomyces dermatitidis two weeks later. While rare, disseminated blastomycosis remains a possibility in an individual with skin and lung lesions. Tentative diagnosis by histopathology can allow for earlier initiation of treatment while awaiting definitive culture, making it an important step in evaluation and management.
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