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Miliary pulmonary blastomycosis.

C B Stelling, J H Woodring, S R Rehm

    Radiology
    |January 1, 1984
    PubMed
    Summary
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    Blastomycosis can cause a miliary pattern on chest X-rays, especially in endemic regions. Diagnosis requires organism recovery, as skin and serologic tests are unreliable for active disease.

    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.

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  • 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.