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Reactivation blastomycosis presenting as a tuboovarian abscess
Abstract:
A 32-year-old Korean woman presented with a rapidly enlarging abdominal mass six months after an undiagnosed illness of fever and a large pleural effusion. Exfoliative cytology of a cervical discharge revealed Blastomyces dermatiditis. At laparotomy, a large peritoneal inclusion cyst was found surrounding a tuboovarian abscess with involvement from the cervix to the peritoneum. B dermatiditis was cultured from the excised uterus and fallopian tube. Female genital blastomycosis has rarely been described. The importance of cytology in making the diagnosis in the present case is emphasized.
Insights
A rare case of female genital blastomycosis was diagnosed using cytology in a Korean woman presenting with an abdominal mass. The fungal infection, Blastomyces dermatitidis, affected the reproductive organs and peritoneum.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Gynecologic Pathology
Background:
- Blastomycosis is a fungal infection typically affecting the lungs.
- Female genital involvement by Blastomyces dermatitidis is exceptionally rare in medical literature.
- Diagnosis often relies on culture, but cytology can be crucial in specific presentations.
Observation:
- A 32-year-old woman presented with a rapidly growing abdominal mass.
- Initial symptoms included undiagnosed fever and pleural effusion six months prior.
- Exfoliative cytology of cervical discharge revealed Blastomyces dermatitidis.
Findings:
- Laparotomy identified a large peritoneal inclusion cyst encasing a tuboovarian abscess.
- The infection extended from the cervix to the peritoneum.
- Blastomyces dermatitidis was successfully cultured from excised uterine and fallopian tube tissues.
Implications:
- This case highlights the diagnostic utility of exfoliative cytology for detecting unusual fungal infections.
- It expands the known spectrum of Blastomyces dermatitidis presentation in women.
- Emphasizes the need for considering fungal causes in complex gynecologic and abdominal pathologies.