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25 November 2021 : Case report  USA

[In Press] A Case Report of a 74-Year-Old Immunocompromised Host Diagnosed with Pulmonary Blastomycosis and Pulmonary Hemorrhage

Rare disease

Aubrey Abbas1DEF, Jaclyn M. Yankle1EF, Michael Apostolis2ADE, Indra Limbu3D, Vincent Peyko4DEF

DOI: 10.12659/AJCR.935059

Am J Case Rep In Press; DOI: 10.12659/AJCR.935059  

Available online: 2021-11-25, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Blastomycosis is a rare opportunistic disease caused by inhalation of the fungus Blastomyces dermatitidis. Blastomycosis can occur in all individuals but is most commonly seen in immunocompromised hosts. If left untreated or not caught early enough, blastomycosis can progress to fulminant multilobar pneumonia, acute respiratory distress syndrome (ARDS), and even death.
CASE REPORT
A 74-year-old immunocompromised man in northeast Ohio presented to the Emergency Department with shortness of breath and hemoptysis. The patient had a negative evaluation for a gastrointestinal bleed and was found to have significant blood collection in the larynx and trachea. A bronchoscopy demonstrated right upper lobe hemorrhage and an infection with Blastomyces species. The patient was started on amphotericin B 5 mg/kg every 24 h for severe blastomycosis. The patient continued to have pulmonary hemorrhage and progressed to multilobar pneumonia and ARDS. Ultimately, the patient died due to respiratory distress after being hospitalized for 5 days.
CONCLUSIONS
Blastomycosis can present with multiple clinical manifestations, including pulmonary hemorrhage, in severe disease. Diagnostic delay of blastomycosis is common owing to a nonspecific patient presentation. Blastomycosis is an opportunistic infection; therefore, the fungus can be more commonly seen within immunocompromised hosts. The combination of diagnostic delay and immunocompromised hosts leads to an increased mortality rate from blastomycosis infections.

Keywords: Blastomycosis; Hemorrhage; Immunocompromised Host

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923