Table 1.
Clinical Characteristics of Patients With Blastomycosis
| Patient | Age (Years); Sex | History | Immunocompromised | Blastomycosis Presentation (Severity, Acuity, Pulmonary Imaging) | Proven/Probable: Culture or Histopathology | Dissemination: Organ Involvement |
|---|---|---|---|---|---|---|
| 1 | 47; Female | Diabetes mellitus | No | Moderate, acute, miliary nodules | Proven: BAL cultured Blastomyces dermatitidis | Yes: pulmonary, CNS |
| 2 | 69; Male | ESRD, OHTx 14 years prior on MMF, tacrolimus | Yes | Moderate, acute, cavitary nodule | Proven: transbronchial biopsy Necrotizing granulomas with BBB yeast culture grew B dermatitidis | Yes: pulmonary, CNS |
| 3 | 53; Female | No comorbidities | No | Mild, chronic, nodules | Proven: skin biopsy with BBB and grew B dermatitidis | Yes: pulmonary, cutaneous |
| 4 | 48; Male | CKD, LURTx 4 years prior on MMF, tacrolimus, prednisone | Yes | Moderate, acute, nodules | Proven: brain biopsy with filamentous fungi and grew B dermatitidis | Yes: pulmonary, CNS, possible prostate |
| 5 | 46; Female | CKD, DBDRTx 3 years prior on azathioprine, prednisone | Yes | Moderate, acute, nodules | Proven: BAL with BBB and grew B dermatitidis | No: isolated pulmonary |
| 6 | 57; Male | Diabetes mellitus, COPD | No | Moderate, chronic, ground-glass opacities | Proven: vertebral bone bx with BBB and grew B dermatitidis | Yes: pulmonary, bone |
| 7 | 53; Male | Diabetes mellitus, CKD, DBDRTx 4 months prior on MMF, tacrolimus, prednisone | Yes | Severe, acute, miliary nodules | Proven: skin biopsy, synovial fluid, BAL with BBB and grew B dermatitidis | Yes: pulmonary, CNS, cutaneous, joint |
| 8 | 66; Male | Diabetes mellitus, restrictive lung disease | No | Mild, chronic, nodules | Probable: skin biopsy with yeast not definitive for Blastomyces spp | Yes: pulmonary, probable cutaneous |
| 9 | 57; Male | Diabetes mellitus, CKD, DCDRTx 1 year prior on MMF, prednisone, belatacept | Yes | Severe, subacute, consolidation with effusion | Proven: skin with BBB and grew B dermatitidis | Yes: pulmonary, probable CNS, cutaneous |
| 10 | 62; Female | Crohn’s Disease on infliximab | Yes | Moderate, acute, consolidation | Probable: transbronchial biopsy with granulomas, no yeast | No: isolated pulmonary |
| 11 | 26; Male | No comorbidities | No | Moderate, chronic, Consolidation | Proven: BAL, transbronchial biopsy, NP mass Bx with BBB and grew B dermatitidis | Yes: pulmonary, CNS, cutaneous, bone |
| 12 | 38; Male | No comorbidities | No | Moderate, acute, cavitary nodule | Proven: BAL with BBB and grew B dermatitidis | Yes: pulmonary, probable CNS |
| 13 | 21; Female | No comorbidities | No | Mild, acute, ground-glass opacities | Probable: no culture or histopathology | No: isolated pulmonary |
| 14 | 53; Female | ESRD, Cystic Fibrosis, DBDBLTx 6 year prior on MMF, cyclosporine, prednisone | Yes | Moderate, acute, consolidation | Proven: BAL with BBB and grew B dermatitidis | No: isolated pulmonary |
Abbreviations: BAL, bronchoalveolar lavage; BBB, broad-based budding yeast; bx, biopsy; CNS, central nervous system; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; DBDBLTx, donor after brain death bilateral lung transplantation; DBDRTx, donor after brain death renal transplantation; DCDRTx, donor after cardiac death renal transplantation; ESRD, end-stage renal disease; LURTx, live unrelated renal transplantation; MMF, mycophenolate mofetil; NP, nasopharyngeal; OHTx, orthotopic heart transplantation.