SHM Converge Scientific Abstract ePoster Gallery-Disseminated Blastomycosis in Pregnancy: Indian Reservations, Wisconsin, and Treatment

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Blastomycosis is a fungal infection that commonly affects the lungs but can spread to other organs if not controlled. It is more common in certain populations, including Native Americans, and in endemic regions such as the Great Lakes area. Blastomycosis in pregnancy is very rare, but it is dangerous because transplacental spread can occur and may lead to fetal demise.<br /><br />The case describes a 29-year-old woman who was 20 weeks pregnant and developed back pain, shortness of breath, chest pain, and hemoptysis. Initially treated as pneumonia with azithromycin, she later had CT findings suspicious for malignancy, but biopsy confirmed blastomycosis. Her exposure history included living near an Indian reservation in northern Wisconsin and frequent hiking in wooded areas, both consistent with endemic environmental exposure.<br /><br />Because she had signs of possible disseminated disease, she was started on amphotericin B, the preferred treatment in pregnancy. MRI showed no central nervous system involvement, allowing dose reduction. She was discharged with a PICC line for long-term amphotericin B infusions, with a plan to switch to oral azoles after breastfeeding.<br /><br />The discussion emphasizes that pregnancy increases susceptibility to infection due to its immunosuppressive state. Although itraconazole and other azoles are first-line treatments for blastomycosis in nonpregnant patients, they are contraindicated in pregnancy because of teratogenic risks. Amphotericin B is safer in pregnancy, but patients require close monitoring of kidney function, electrolytes, and liver tests.

Asset Subtitle

Elliott E. Paintsil

Meta Tag

Author List Corey Briska, Elliott E. Paintsil, Natalie Anumolu, Pinky Jha

Category Clinical Vignettes

Concept Blastomycosis

Concept Amphotericin B

Concept Pulmonary Disease

Concept Disseminated Disease

Concept Pregnancy

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Elliott E. Paintsil

Track Adult

Keywords

blastomycosis

pregnancy

fungal infection

amphotericin B

endemic regions

Great Lakes

Native Americans

transplacental spread

disseminated disease

itraconazole

Blastomycosis

Amphotericin B

Pulmonary Disease

Disseminated Disease

Pregnancy