SHM Converge Scientific Abstract ePoster Gallery-Blasted Joints and Lungs : A Case of Disseminated Blastomycosis

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This case report describes a rare, severe presentation of disseminated blastomycosis leading to acute respiratory distress syndrome (ARDS) and death despite treatment. Blastomycosis is an uncommon endemic fungal infection, and ARDS secondary to blastomycosis is especially rare but highly lethal. The text notes that in one study of 123 patients, about 8% developed ARDS and 78% of those patients died from respiratory failure. Because the disease is uncommon, it is often missed or diagnosed late, which worsens outcomes.<br /><br />The patient was a 54-year-old man with a history of tobacco use and low-grade prostate cancer. He presented with worsening dysphagia, 15-pound weight loss, progressive knee pain and swelling, and painful non-itchy skin lesions on his nose and extremities. He also reported workplace exposure to dust, asbestos, and silica. On admission, he had marked leukocytosis, thrombocytosis, elevated ESR, and abnormal liver enzymes. Initial infectious testing, including blood cultures, HIV, hepatitis, tick-borne testing, and QuantiFERON Gold, was negative. CT imaging showed calcified pharyngeal wall mucosa and diffuse miliary pulmonary nodules.<br /><br />Despite broad-spectrum antibiotics, he deteriorated with fevers, hypotension, and worsening hypoxia. He was found to have right knee septic arthritis with a gastrocnemius abscess and femoral osteomyelitis, requiring surgical source control. Bronchoscopy later revealed diffuse nodular lung disease, and biopsy confirmed blastomycosis. He was started on amphotericin B, the recommended treatment for disseminated disease, but progressed to ARDS and ultimately died from multisystem organ failure.<br /><br />The report emphasizes that disseminated blastomycosis can occur even in immunocompetent patients and should be considered in patients with refractory respiratory symptoms, especially in endemic areas or with compatible extrapulmonary findings.

Asset Subtitle

Deepa Kumarjiguda

Meta Tag

Author List Deepa Kumarjiguda, Jamie Hood, Shreya Vatsala, Sonu Santosh

Category Clinical Vignettes

Concept Blastomycosis

Concept Disseminated Blastomycosis

Concept Amphotericin B

Concept Pulmonary Disease

Concept Acute Respiratory Distress Syndrome

Distinguished Non-Finalist

Presenter Organization Geisinger Medical Center

Presenting Author Deepa Kumarjiguda

Track Adult

Keywords

blastomycosis

disseminated fungal infection

acute respiratory distress syndrome

ARDS

endemic mycosis

multisystem organ failure

pulmonary nodules

septic arthritis

amphotericin B

immunocompetent patient

Blastomycosis

Disseminated Blastomycosis

Amphotericin B

Pulmonary Disease

Acute Respiratory Distress Syndrome