22 April 2023: Articles
Classical Presentation of Disseminated Blastomycosis in a 44-Year-Old Healthy Man 3 Months After Diagnosis of COVID-19
Challenging differential diagnosis, Rare disease
Diana Fan A , Ali Ahmad A , Jared Frisby D , Kavita Darji B , Ashley Ojeaga B , Ramona Behshad B , M. Yadira Hurley B , Mallory Abate B , Paul Kunnath A*DOI: 10.12659/AJCR.938659
Am J Case Rep 2023; 24:e938659
Table 1. A full account of the laboratory results from a 44-year-old man with a diagnosis of blastomycosis. Common laboratory tests, bacterial, viral, and fungal infectious workup, and immune studies are reported. Results are reported as either positive/ abnormal or negative/normal. Numerical values are reported when applicable with the normal ranges in parenthesis.
| Positive/abnormal | Negative/normal | |
|---|---|---|
| Common labs | WBC 18.7 (white blood cells) | Procalcitonin 0.10 |
| ESR >130 (0–15) (erythrocyte sedimentation rate) | Lactic acid 0.8 | |
| CRP 16.6 ( | ||
| Infectious (bacterial) | -- | Legionella urine antigen |
| -- | Treponemal reverse cascade | |
| -- | Urine chlamydia PCR | |
| -- | Urine gonococcal PCR | |
| -- | QuantiFERON-TB gold plus 0.01 | |
| -- | MRSA nasopharyngeal PCR | |
| -- | Strep pneumo urine antigen | |
| Infectious (viral) | -- | COVID-19 nasopharyngeal PCR |
| -- | Hepatitis C antibody | |
| Infectious (fungal) | Beta-D-Glucan positive | Histoplasma galactomannan urine antigen |
| Blastomyces antigen urine >200 | Blastomyces antibody | |
| -- | Coccidioides antibody IgG 0.2 | |
| -- | Cryptococcus blood antigen | |
| -- | Aspergillus galactomannan antigen | |
| -- | BAL/blood 0.04 (bronchoalveolar lavage) | |
| Immunocompromise | Immunoglobulin panel: IgG 2110 (767–1590), IgM 41, IgA 693 (61–356) | HIV1/2 ab + HIV p24 antigen panel |
| -- | HIV-1 RNA quant PCR | |
| -- | Complement C3/C4 | |
| -- | CD4 absolute=942, CD4%=53 | |
| Misc | -- | ACE 12 (9–67) (angiotensin-converting enzyme) |
| -- | ANA IgG (antinuclear antibodies) | |
| -- | ANCA vasculitis panel: MPO 0, serine proteinase 3 (PR3) IgG 7, ANCA† Titer IFA | |
| -- | MPO/PR3 serine proteinase 3 IgG=5 | |
| PCR – polymerase chain reaction; ANCA – antineutrophil cytoplasmic antibodies; MPO – myeloperoxidase. | ||