Miliary pulmonary blastomycosis

Area of Science:

• Pulmonary Medicine
• Infectious Diseases
• Radiology

Background:

• Blastomycosis is a fungal infection endemic to North America.
• Disseminated blastomycosis can present with diverse radiographic findings.
• A miliary pattern on chest radiographs is uncommon but recognized in disseminated fungal infections.

Purpose of the Study:

• To highlight blastomycosis as a potential cause of a miliary pattern on chest radiographs.
• To emphasize the diagnostic challenges and importance of definitive organism identification.
• To underscore the need for prompt diagnosis and treatment in endemic areas.

Main Methods:

• Case series presentation of five patients with confirmed blastomycosis.
• Review of chest radiographic findings, specifically the diffuse miliary nodular pattern.
• Correlation of radiographic findings with clinical presentation and microbiological documentation.

Main Results:

• All five patients presented with a diffuse miliary nodular pattern on chest radiographs.
• Blastomycosis was confirmed through organism recovery from body fluids or tissue.
• Skin and serologic tests were found to be unreliable for diagnosing active disease in these cases.

Conclusions:

• Blastomycosis should be considered in the differential diagnosis of miliary patterns on chest radiographs in endemic areas.
• Definitive diagnosis relies on microbiological confirmation, not solely on serologic or skin testing.
• Early diagnosis and treatment are crucial for patient recovery and preventing fatal outcomes, especially in immunocompromised individuals.