Potentially Preventable? A Case of Recurrent Blastomycosis Involving the Central Nervous System

Area of Science:

• Mycology
• Infectious Diseases
• Neurology

Background:

• Blastomycosis is a fungal infection caused by *Blastomyces* species.
• Central nervous system (CNS) involvement occurs in 1-10% of blastomycosis cases.
• Treatment typically requires prolonged antifungal therapy, often exceeding 12 months.

Observation:

• A 32-year-old male presented with recurrent CNS blastomycosis, including a cerebellar abscess.
• Initial treatment was interrupted due to the patient's inability to afford prescribed oral voriconazole.
• The patient experienced relapse, necessitating surgical intervention and reinitiation of antifungal therapy.

Findings:

• Successful treatment of recurrent CNS blastomycosis was achieved after addressing financial barriers to medication.
• Complete adherence to a year-long antifungal regimen, including voriconazole, was crucial for recovery.
• Early engagement of social work facilitated medication access and improved patient outcomes.

Implications:

• Medication cost is a significant factor influencing treatment adherence and clinical outcomes in blastomycosis.
• Healthcare providers must consider and discuss medication affordability with patients.
• Integrated care approaches, including social work, are vital for managing complex infectious diseases.