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Case report: miliary blastomycosis with cerebral involvement

J W Rippon, J R Zvetina, C Reyes

    Mycopathologia
    |February 18, 1977
    PubMed
    Summary

    A patient with brain tumor and labyrinthitis developed miliary lung nodules. Autopsy revealed disseminated Blastomyces dermatitidis infection, highlighting a rare presentation of fungal granulomas.

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    Area of Science:

    • Mycology
    • Infectious Diseases
    • Neurology

    Background:

    • A patient presented with labyrinthitis and an intracranial brain tumor.
    • Initial chest roentgenogram showed fine nodularity in bronchopulmonary markings.

    Observation:

    • Subsequent imaging revealed diffuse nodular densities in both lung fields, consistent with miliary distribution.
    • Empirical antituberculous therapy was initiated.

    Findings:

    • The patient expired within three weeks.
    • Autopsy identified multiple granulomas in the cerebrum, cerebellum, and meninges.
    • Histologic examination and culture confirmed Blastomyces dermatitidis as the causative agent.
    • The lungs exhibited numerous small granulomata, replacing native architecture.
    • Disseminated lesions were also noted in the spleen, lymph nodes, and pancreas.

    Implications:

    • This case underscores the potential for Blastomyces dermatitidis to cause disseminated disease mimicking miliary tuberculosis.
    • It highlights the importance of considering fungal infections in patients with unexplained miliary patterns and central nervous system involvement.
    • Early and accurate diagnosis is crucial for effective management of disseminated fungal infections.

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