Identifying Rare Fungal Disease: A Cutaneous Blastomycosis Case Report

Introduction Blastomycosis is a fungal infection caused by inhalation of Blastomyces dermatitidis spores. Half of infections are asymptomatic, but mild disease presents with pulmonary findings such as pneumonia that is generally self-limited in immunocompetent patients. Disseminated disease occurs more commonly in immunocompromised patients with the most common extrapulmonary finding being skin lesions. Case Report The patient is a 32 year old immunocompetent male living in Southern Illinois with no significant past medical history. The patient endorsed several months of hemoptysis and dyspnea. On presentation to dermatology, the patient had a 5 cm erythematous ulcerated plaque on his right upper chest. Tissue culture showed deep fungal infection that was positive for blastomycosis. The patient was referred to infectious disease and placed on a 6-12 month regimen of itraconazole. After the first month of treatment, the patient noted that his lesion had decreased in size and that he was no longer coughing up blood. Discussion Cutaneous blastomycosis presents a diagnostic challenge due to rarity and its varied clinical manifestations. This geographical prevalence is significant for patient diagnosis, especially for those originating from these areas. Despite its infrequent occurrence, cutaneous blastomycosis should be included in differentials for ulcerated skin lesions, especially in patients with predisposing risk factors like outdoor occupations, recreational activities in wooded areas, or immunocompromised states. The disease often masquerades as other common dermatological conditions.