Chris Schach

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Key Points
*Rare fungal infection
*Primarily affects the lungs
*In approximately 20% of cases, the skin becomes involved
*Cutaneous symptoms consist of lesions which form on the face, neck and extremities

Blastomycosis is a rare fungal infection that most commonly affects the lungs. Symptoms can range from flu and pneumonia-like to chronic appearances which resemble Tuberculosis, lung cancer, and acute respiratory distress syndrome. Over half of affected persons exhibit minimal symptoms, but in acute cases, 20-40% of patients see involvement of the skin. Cutaneous symptoms consist of popular, nodular or pustular lesions which form on the face, neck and extremities. These lesions will ulcerate over a period of weeks, growing larger over time and healing to form raised Scars. Lesions can cause severe, disfiguring scarring over the face. Symptoms may not begin for 3-4 weeks following exposure.

Blastomycosis is caused by breathing in spores from contaminated soil or wood. While it can be found in all parts of the world, the fungus is most common in south-central and mid-western US and Canada. People of all ages and sexes are capable of being infected, but those with weakened immune systems are more vulnerable. There are approximately 1-2 cases per 100,000 people every year.

Differential Diagnosis (Other conditions with similar appearance)

Bacterial pneumonia

Key Points
*Diagnosis based on lab and radiological testing
*Biopsy may be performed on cutaneous involvement

Blastomycosis is generally diagnosed through laboratory and radiological testing after presentation of symptoms. If cutaneous involvement occurs, skin and tissue biopsies may be performed. Patient history and location may also be important in diagnosis.

*Mild cases confined to the lungs usually do not require treatment
*Goal of treatment is to eliminate the causative fungus
*If cutaneous involvement occurs, treatment is necessary

As long as Blastomycosis is confined to the lungs and symptoms are mild, treatment is generally not required and the infection will resolve on its own. In cases with severe lung symptoms and cutaneous involvement, health care professionals may prescribe Itraconazole to combat the infection. In life-threatening cases, amphotericin B is administered intravenously.

Affected persons with limited symptoms, even cases which spread to the skin, can recover completely. If left untreated, the condition can lead to disfigurement and death.

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