Monday, October 24, 2022

most common extrapulmonary site of infection for blastomycosis

Q: Which is the most common extrapulmonary site of infection for blastomycosis? - select one

A) Skin
B) Bone and joint
C) Genitourinary system 
D) Central nervous system
E) Adrenal gland


Answer: A

Pneumonia is the most common presentation in blastomycosis. The acute phase of pneumonia is usually missed as symptoms are almost impossible to distinguish from other common causes of pneumonia/pneumonitis. Patients are usually in a chronic pneumonia phase at the presentation time and carry other extrapulmonary symptoms. The findings on the skin are the most helpful clues after history and epidemiological distribution. A patient may present with a verrucous lesion with irregular borders of gray to violet colors. 

Their appearance is very close to squamous cell carcinoma and may prompt biopsy, which reveals the diagnosis with the presence of microabscesses at the periphery of the lesions and broad-based budding organisms. Lesions are usually ulcerative lesions and may bleed easily.

#ID
#dermatology


References:

1. G Caldito E, Ajiboye O, Flores E, Antia C, Demarais P. The importance of skin exam in chronic pulmonary blastomycosis. IDCases. 2020 May 13;20:e00812. doi: 10.1016/j.idcr.2020.e00812. PMID: 32455114; PMCID: PMC7235621.

2. McBride JA, Gauthier GM, Klein BS. Clinical Manifestations and Treatment of Blastomycosis. Clin Chest Med. 2017 Sep;38(3):435-449. doi: 10.1016/j.ccm.2017.04.006. Epub 2017 Jun 12. PMID: 28797487; PMCID: PMC5657236.

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