IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 5527 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
   [PDF Not available] *
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   Abstract
   Introduction
   Case Report
   Discussion
   References
   Article Figures

 Article Access Statistics
    Viewed2672    
    Printed43    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal

 


 
CASE REPORT
Year : 1996  |  Volume : 62  |  Issue : 2  |  Page : 120-121

Localised cutaneous blastomycosis : Response to fluconazole




Correspondence Address:
R A Bumb


Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 20948001

Rights and PermissionsRights and Permissions

  Abstract 

A case of atypical cutaneous blastomycosis is reported. Patient responded to oral fluconazole 200 mg per day given for 9 months.


Keywords: Cutaneous blastomycosis, Fluconazole


How to cite this article:
Bumb R A, Mehta R D, Kumar K, Saini S. Localised cutaneous blastomycosis : Response to fluconazole. Indian J Dermatol Venereol Leprol 1996;62:120-1

How to cite this URL:
Bumb R A, Mehta R D, Kumar K, Saini S. Localised cutaneous blastomycosis : Response to fluconazole. Indian J Dermatol Venereol Leprol [serial online] 1996 [cited 2019 Jul 18];62:120-1. Available from: http://www.ijdvl.com/text.asp?1996/62/2/120/4339



  Introduction Top


Blastomycosis is a chronic granulomatous and suppurative mycosis caused by Blastomyces dermatitidis. Primarily it involves the pulmonary tissue but secondary dissemination is found in skin, bones and central nervous system. The primary cutaneous blastomycosis is seen in farmers with rural background and laboratory workers.[1] In our country blastomycosis like pyoderma was reported in past[2] but not primary cutaneous blastomycosis. We are reporting a case of atypical localised cutaneous blastomycosis.


  Case Report Top


A 45-year-old man presented with grouped nodules with hard background over right side of loin for about one and a half years. Patient gave history of vague pain at the site of lesion at the begining and then he gradually developed pinkish soft nodules which were painless and non-itchy. There was history of discharge of pus off and on but no discharge of black, yellow or green granules. Gradually the site of lesion became hard. He was given local and systemic antibiotics by the practitioners without any relief. He was a smoker, nonalcoholic, vegetarian and farmer by profession. There was no history of cough, fever, weight loss, or constitutional symptoms.

General examination revealed no abnormality. Examination of nervous system, cardiovascular system, respiratory system, and bones showed no defect. Liver and spleen were not palpable.

Examination of the skin at the affected site showed ill-defined, indurated, nontender, erythematous, plaque over right side of lower back. Plaque was studded with numerous soft pink nodules of 2-10 mm size [Figure - 1]. There was little homogenous discharge from the nodules. There was no enlargement of regional lymph nodes. Routine haematological investigations were within normal limits. Urine examination was normal. X-ray chest and of long bones were normal. CT scan was normal. Pus was sterile on bacterial culture. KOH mount of the scrapings from nodules showed rounded refractile bodies. Fungus culture on Sabouraud's media showed colonies of blastomycosis. Histopathological section showed basophilic homogenous masses surrounded by inflammatory cells with giant cell reaction. Caseation was not seen [Figure - 2].

Patient was treated with oral fluconazole 200 mg per day for 9 months. There was dramatic regression of the lesion in 12 weeks. Fungus culture became negative at the end of 12 weeks. Complete healing took place in 9 months [Figure - 3]. Pitted scarring remained after complete healing. No side effect was reported by the patient with fluconazole.


  Discussion Top


The reported case has the clinical picture of cutaneous form of disseminated blastomycosis which was confirmed by KOH mount and histopathological examination but with no evidence of pulmonary, CNS and bone involvement. The clinical, mycological and histopathological findings ruled out paracoccidioidomycosis or mycetoma. Patient responded to fluconazole as reported in the past also.[3] As per our knowledge, this is the first case of primary cutaneous blastomycosis reported from India.

 
  References Top

1.Larsh HW, Shwartz J. Accidental inoculation blastomycosis. Cutis 1977;19:34-5.  Back to cited text no. 1    
2.Kumar V, Garg BR, Barua MC. Blastomycosis like pyoderma. Ind J Dermatol Venereol Leprol 1990;56:58-60.  Back to cited text no. 2    
3.Pappas PG, Bradsher RW, Chapman SW, Kauffman CA, et al. Treatment of blastomycosis with fluconazole: a pilot study. Clin Infect Dis 1995;20:267-71.  Back to cited text no. 3  [PUBMED]  


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]



 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow