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Blastomycosis presenting as a nonhealing wound.
William R Owen1, Kathy Thurs, David S L Kim
1Department of Dermatology at Ministry Health, Wausau, Wisconsin, USA.
Advances in Skin & Wound Care
|June 21, 2012
Summary
Blastomycosis, a fungal infection, can manifest as skin ulcers. Early diagnosis via biopsy and treatment with itraconazole led to rapid healing of a large arm ulcer.
Area of Science:
- Mycology
- Dermatology
- Infectious Diseases
Background:
- Blastomycosis is a systemic fungal infection caused by inhalation of Blastomyces dermatitidis spores.
- While typically a pulmonary infection, the skin is the most common secondary site of dissemination.
- Cutaneous blastomycosis can present as hyperkeratotic nodules or, less commonly, as ulcerations.
Observation:
- A 41-year-old male presented with a large, 8-month-evolving ulceration on his right upper arm.
- Biopsy revealed broad-based budding spores characteristic of blastomycosis.
Findings:
- The patient was successfully treated with oral itraconazole.
- The extensive skin ulceration healed completely within 2 months of treatment initiation.
Implications:
- Cutaneous blastomycosis, even when presenting as ulcerations, is treatable with antifungal therapy.
- Skin lesions can be crucial for diagnosing systemic blastomycosis in otherwise asymptomatic or unsuspected cases.
- Prompt diagnosis and treatment of blastomycosis are essential to prevent significant morbidity and mortality.
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