Bennie Ho Karen, Ng Maxwell, Tallon Kelsey
Department of Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
J Assoc Med Microbiol Infect Dis Can. 2020 Mar 4;5(1):39-43. doi: 10.3138/jammi.2019-0010. eCollection 2020 Mar.
Although southern Saskatchewan is not known to be a region endemic to blastomycosis, we present a case of disseminated blastomycosis in a 39-year-old man with pulmonary, genitourinary, and osteoarticular involvement. The patient presented with persistent fevers despite recent antibiotic therapy, arthritis in his left foot, and urinary obstruction. A computed tomography (CT) scan of the chest revealed a diffuse miliary pattern. A transbronchial biopsy only showed granulomatous changes, and washings were negative for fungal culture. Magnetic resonance imaging (MRI) of the left foot revealed signs of septic arthritis. Pathology from the joint aspiration and debridement revealed budding yeast in keeping with blastomycosis. Urine culture also grew blastomycosis, confirming urinary involvement. He was initiated on itraconazole, with complete resolution of his symptoms within 2 weeks. This case illustrates the challenges in diagnosing disseminated blastomycosis, and further establishes the endemicity of blastomycosis in southern Saskatchewan.
虽然萨斯喀彻温省南部并非已知的芽生菌病地方流行区，但我们报告了一例39岁男性播散性芽生菌病病例，该病例累及肺部、泌尿生殖系统和骨关节。尽管近期接受了抗生素治疗，患者仍持续发热，伴有左脚关节炎和尿路梗阻。胸部计算机断层扫描（CT）显示弥漫性粟粒样改变。经支气管活检仅显示肉芽肿性改变，冲洗液真菌培养阴性。左脚磁共振成像（MRI）显示脓毒性关节炎迹象。关节穿刺和清创的病理检查发现符合芽生菌病的芽生酵母。尿培养也培养出芽生菌，证实尿路受累。他开始接受伊曲康唑治疗，症状在2周内完全缓解。该病例说明了诊断播散性芽生菌病的挑战，并进一步确定了萨斯喀彻温省南部芽生菌病的地方流行性。
