Walker Karen, Skelton Henry, Smith Kathleen
Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
J Cutan Pathol. 2002 Nov;29(10):616-8. doi: 10.1034/j.1600-0560.2002.291009.x.
The yeast forms of Blastomyces dermatitidis usually range from 8 to 15-20 micro m in diameter. Larger yeast forms have previously been reported only twice in immunosuppressed patients. In both patients these large forms were seen within the lung.
We present a 14-year-old cardiac transplant patient, who presented 36 days following his transplantation with acute respiratory distress followed a few days later by erythematous cutaneous papules.
Biopsy of a skin lesion showed yeast forms, some greater than 40 micro m in diameter, within and surrounding dermal vessels. Cultures later grew Blastomyces dermatitidis.
To our knowledge this is the first reported case of giant forms of Blastomyces dermatitidis within the skin. With increased iatrogenic immunosuppression, we may expect to see more diverse morphologic forms with deep fungal infections.
