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Cutaneous lesions showing giant yeast forms of Blastomyces dermatitidis
Karen Walker1, Henry Skelton, Kathleen Smith
1Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
Background:
The yeast forms of Blastomyces dermatitidis usually range from 8 to 15-20 micro m in diameter. Larger yeast forms have previously been reported only twice in immunosuppressed patients. In both patients these large forms were seen within the lung.
Case Report:
We present a 14-year-old cardiac transplant patient, who presented 36 days following his transplantation with acute respiratory distress followed a few days later by erythematous cutaneous papules.
Results:
Biopsy of a skin lesion showed yeast forms, some greater than 40 micro m in diameter, within and surrounding dermal vessels. Cultures later grew Blastomyces dermatitidis.
Conclusions:
To our knowledge this is the first reported case of giant forms of Blastomyces dermatitidis within the skin. With increased iatrogenic immunosuppression, we may expect to see more diverse morphologic forms with deep fungal infections.
Insights
Giant Blastomyces dermatitidis yeast forms, over 40 micro m, were found in the skin of an immunosuppressed cardiac transplant patient. This is the first report of these large fungal forms presenting in cutaneous lesions.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Immunocompromised Hosts
Background:
- Blastomyces dermatitidis yeast forms typically measure 8-20 micro m.
- Larger forms (>20 micro m) are rare, previously reported only twice in lung tissue of immunosuppressed individuals.
- This study investigates an unusual presentation of B. dermatitidis in a cardiac transplant recipient.
Observation:
- A 14-year-old cardiac transplant patient developed acute respiratory distress post-transplant.
- Cutaneous papules appeared days after respiratory symptoms.
- Skin biopsy revealed yeast forms exceeding 40 micro m, associated with dermal vessels.
Findings:
- Cultures confirmed the presence of Blastomyces dermatitidis.
- Histopathology demonstrated unusually large yeast forms within and around dermal blood vessels.
- This represents the first documented instance of giant B. dermatitidis forms in skin lesions.
Implications:
- Increased use of iatrogenic immunosuppression may lead to diverse morphologic presentations of deep fungal infections.
- Clinicians should consider unusual fungal morphologies in immunocompromised patients with atypical presentations.
- This case highlights the importance of recognizing novel presentations of B. dermatitidis in the context of evolving immunosuppressive therapies.