Central Extracorporeal Membrane Oxygenation Support for Blastomycosis-Induced Septic Shock

Blastomyces dermatitidis, a rare fungus endemic to the central North America, has the potential to cause respiratory dysfunction in both immunocompromised and immunocompetent hosts. Blastomycosis infections can progress to severe respiratory failure and multisystem organ failure. Extracorporeal membrane oxygenation (ECMO) can be used as a temporary support device to allow time for a patient's organs to recover. Central ECMO has proven to be a successful treatment option for high-output septic shock. This case report describes a 12-year-old girl, erroneously diagnosed with juvenile idiopathic arthritis and treated with immunosuppressives, afflicted with blastomycosis-induced septic shock. High-flow central ECMO was used to reverse her lactic acidosis by increasing oxygen delivery. Unfortunately, continued lung deterioration secondary to the B. dermatitidis infection caused irreversible damage to the lung parenchyma. This is the second pediatric ECMO case report for severe respiratory failure related to blastomycosis and the first case report on central ECMO support for high-output septic shock from blastomycosis.