Abdallah Fatma Chermiti Ben, Bachouch Imène, Belloumi Nidhal, Kacem Marwa, Mlika Mouna, Mezni Faouzi El, Fenniche Soraya
Service de Pneumologie IV, Faculté de Médecine de Tunis, Hôpital Abderrahmen Mami Ariana, Tunis, Tunisie.
Service d'Anatomie Pathologique, Faculté de Médecine de Tunis, Hôpital Abderrahmen Mami Ariana, Tunis, Tunisie.
Pan Afr Med J. 2020 Jul 28;36:220. doi: 10.11604/pamj.2020.36.220.21829. eCollection 2020.
Blastomycosis is a rare fungal disease in Africa which is often due to inhalation of "Blastomyces dermatitidis". Pulmonary blastomycosis is the most common clinical manifestation which presents with a variety of clinical features, ranging from asymptomatic to rapidly fatal. We report the case of a Tunisian patient aged 35 years with no previous medical history, hospitalized with chronic cough, bilateral basithoracic pain, fever and weight loss. Clincal examination showed fever and left paravertebral subcutaneous swelling next to the tenth thoracic vertebra (T10). Chest imaging objectified bilateral alveolar and nodular opacities with excavations in some places. Sputum stain for Koch bacillus (BK) was negative (direct examination and culture). Bronchial fibroscopy was normal. Anatomopathological examination of dorsal mass biopsy revealed blastomycosis. The diagnosis was confirmed by cultures of the biopsic fragments of the mass. Antifungal therapy with itraconazole was started with clinical and radiological improvement. This case study highlights challenges in the diagnosis of blastomycosis in our country, in particular when lesions mimick tuberculosis; hence delayed therapy.
芽生菌病是非洲一种罕见的真菌病，通常由吸入“皮炎芽生菌”引起。肺芽生菌病是最常见的临床表现，具有多种临床特征，从无症状到迅速致命不等。我们报告了一例35岁的突尼斯患者，既往无病史，因慢性咳嗽、双侧胸廓底部疼痛、发热和体重减轻入院。临床检查发现发热，第十胸椎（T10）旁左侧椎旁皮下肿胀。胸部影像学检查显示双侧肺泡和结节状混浊，部分部位有空洞。痰涂片抗酸杆菌（BK）阴性（直接检查和培养）。支气管纤维镜检查正常。背部肿块活检的组织病理学检查显示为芽生菌病。通过肿块活检碎片的培养确诊。开始使用伊曲康唑进行抗真菌治疗，临床和影像学均有改善。本病例研究突出了我国芽生菌病诊断中的挑战，特别是当病变类似结核病时；因此治疗延迟。
