Skip to content
1887

JMM Case Reports JMM Case Reports

Volume 2, Issue 1

Extrapulmonary intrathoracic blastomycosis: a case report and systematic literature review Open Access

Abstract

Introduction:

Mediastinal blastomycosis has been described in multiple case reports, but no review to date has catalogued its various manifestations or response to treatment.

Case presentation:

An otherwise healthy 18‐year‐old female presented with lymphadenopathy and was found to have a large mediastinal mass concerning for lymphoma. A subsequent biopsy revealed ; the patient responded well to therapy with amphotericin B and itraconazole. Similar cases are reviewed and analysed.

Conclusion:

Mediastinal blastomycosis is a rare but life‐threatening disease manifestation that responds readily to appropriate antifungal therapy.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): Blastomyces , blastomycosis , Gilchrist's disease and mediastinal mass lesion
© 2015 The Authors
  • This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/).
Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.000022
2015-02-01
2026-01-24

Metrics

Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/2/1/jmmcr000022.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.000022&mimeType=html&fmt=ahah

References

  1. Abernathy R.S. ( 1959). Clinical manifestations of pulmonary blastomycosis. Ann Intern Med 51:707–727 [CrossRef]
     [Google Scholar]
  2. Alhaji M., Sadikot R.T. ( 2013). Respiratory failure due to blastomycosis infection in a patient with hypertension, cirrhosis and chronic pancreatitis. Expert Rev Respir Med 7:583–585 [CrossRef]
     [Google Scholar]
  3. Arabi Y., Abbas M., Fairfax M.R. ( 1996). Dissemination of pulmonary blastomycosis after thoracotomy. Diagn Microbiol Infect Dis 26:35–37 [CrossRef]
     [Google Scholar]
  4. Arsura E.L., Bobba R.K., Reddy C.M. ( 2004). Coccidioidal pericarditis: a case presentation and review of the litareature. Int J Infect Dis 9:104–109 [CrossRef]
     [Google Scholar]
  5. Baker R.D., Brian E.W. ( 1937). Blastomycosis of the heart: report of two cases. Am J Pathol 13:139–147
     [Google Scholar]
  6. Camacho M.T., Edelman M., Rozenblit A., McKitrick J.C., Pinsker K., Fell S.C. ( 1996). Mediastinal histoplasmosis causing massive hematemesis. J Thorac Cardiovasc Surg 111:1283–1286 [CrossRef]
     [Google Scholar]
  7. Carlos W.G., Rose A.S., Wheat L.J., Norris S., Sarosi G.A., Knox K.S., Hage C.A. ( 2010). Blastomycosis in Indiana: digging up more cases. Chest 138:1377–1382 [CrossRef]
     [Google Scholar]
  8. Chapman S.W., Lin A.C., Hendricks K.A., Nolan R.L., Currier M.M., Morris K.R., Turner H.R. ( 1997). Endemic blastomycosis in Mississippi: epidemiological and clinical studies. Semin Respir Infect 12:219–228
     [Google Scholar]
  9. Chapman S.W., Dismukes W.E., Proia L.A., Bradsher R.W., Pappas P.G., Threlkeld M.G., Kauffman C.A. ( 2008). Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis 46:1801–1812 [CrossRef]
     [Google Scholar]
  10. Cherniss E.I., Waisbren B.A. ( 1956). North American blastomycosis: a clinical study of 40 cases. Ann Intern Med 44:105–123 [CrossRef]
     [Google Scholar]
  11. Churchill T., Stober A.M., Alvin M. ( 1915). A case of systemic blastomycosis. Arch Intern Med568–574
     [Google Scholar]
  12. Cleary J. ( 1904). A case of generalized blastomycosis. Medicine 6:818
     [Google Scholar]
  13. Coupal J. ( 1924). Report of six cases of blastomycosis. Int Clin 4:1–14
     [Google Scholar]
  14. Diaz M., Puente R., de Hoyos L.A., Cruz S. ( 1991). Itraconazole in the treatment of coccidioidomycosis. Chest 100:682–684 [CrossRef]
     [Google Scholar]
  15. Dodds G.A. ( 1962). Pulmonary blastomycosis: case report of treatment with amphotericin B. Lancet 82:255–257
     [Google Scholar]
  16. Dworkin M.S., Duckro A.N., Proia L., Semel J.D., Huhn G. ( 2005). The epidemiology of blastomycosis in Illinois and factors associated with death. Clin Infect Dis 41:107–111 [CrossRef]
     [Google Scholar]
  17. el‐Naggar B.A., Wishahy A.O., Rifaat M.A., Morsy T.A. ( 1971). Toxoplasmosis in an Egyptian child with mediastinal lymphadenopathy. J Trop Med Hyg 74:82
     [Google Scholar]
  18. Howes W.B., Morse P.F. ( 1921). Report of two cases of blastomycosis. Boston Med Surg J 185:315–317 [CrossRef]
     [Google Scholar]
  19. Hurley T.D. ( 1916). An unique lesion of the heart in systemic blastomycosis. J Med Res 33:499–502
     [Google Scholar]
  20. Jay S.J., O’Neill R.P., Goodman N., Penman R. ( 1977). Pleural effusion: a rare manifestation of acute pulmonary blastomycosis. Am J Med Sci 274:325–328 [CrossRef]
     [Google Scholar]
  21. Kaplan W., Clifford M.K. ( 1964). Blastomycosis I: a review of 198 collected cases in Veterans Administration Hospitals. Am Rev Respir Dis 89:659–672
     [Google Scholar]
  22. Khandekar A., Moser D., Fidler W.J. ( 1980). Blastomycosis of the esophagus. Ann Thorac Surg 30:76–79 [CrossRef]
     [Google Scholar]
  23. Kinasewitz G.T., Penn R.L., George R.B. ( 1983). The spectrum and significance of pleural disease in blastomycosis. Chest 86:580–584 [CrossRef]
     [Google Scholar]
  24. Kitchen M.S., Reiber C.D., Eastin G.B. ( 1977). An urban epidemic of North American blastomycosis. Am Rev Resp Disord 115:1063–1066
     [Google Scholar]
  25. Kralt D., Light B., Cheang M., MacNair T., Wiebe L., Limerick B., Sarsfield P., Hammond G., MacDonald K. other authors( 2009). Clinical characteristics and outcomes in patients with pulmonary blastomycosis. Mycopathologia 167:115–124 [CrossRef]
     [Google Scholar]
  26. Kroe D.M., Shulman N., Kirsch C.M., Wehner J.H. ( 1997). An anterior mediastinal mass with draining sternal sinus tracts due to Nocardia braziliensis. West J Med 167:47–49
     [Google Scholar]
  27. Lagerstrom C.F., Mitchell H.G., Graham B.S., Hammon J.W. ( 1992). Chronic fibrosing mediastinitis and superior vena caval obstruction from blastomycosis. Ann Thorac Surg 54:764–765 [CrossRef]
     [Google Scholar]
  28. Landay M.J., Rollins N.K. ( 1989). Mediastinal histoplasmosis granuloma: evaluation with CT. Radiology 172:657–659 [CrossRef]
     [Google Scholar]
  29. LeCount E. ( 1915). Miliary blastomycotic retrogressive lymphangitis of the epicardium. Bull Johns Hopkins Hosp 295:315–316
     [Google Scholar]
  30. Light B.R., Kralt D., Embil J.M., Trepman E., Wiebe L., Limerick B., Sarsfield P., Hammond G., MacDonald K. ( 2008). Seasonal variations in the clinical presentation of pulmonary and extrapulmonary blastomycosis. Med Mycol 46:835–841 [CrossRef]
     [Google Scholar]
  31. Loyd J.E., Tillman B.F., Atkinson J.B., Des Prez R.M. ( 1988). Mediastinal fibrosis complicating histoplasmosis. Medicine 67:295–310 [CrossRef]
     [Google Scholar]
  32. McKenzie R., Khakoo R. ( 1985). Blastomycosis of the esophagus presenting with gastrointestinal bleeding. Gastroenterology 88:1271–1273
     [Google Scholar]
  33. Medlar E.M. ( 1927). Pulmonary blastomycosis; its similarity to tuberculosis. Report of two cases. Am J Pathol 3:305–314
     [Google Scholar]
  34. Neuzil K.M., Mitchell H.C., Loyd J.E., Lagerstrom C.F., Hammon J.W., Graham B.S. ( 1994). Extrapulmonary thoracic disease caused by Blastomyces dermatitidis . Chest 106:1885–1887 [CrossRef]
     [Google Scholar]
  35. Ng K.K., Cheng Y.F., Ko S.F., Ng S.H., Pai S.C., Tsai C.C. ( 1992). CT findings of pediatric thoracic actinomycosis: report of four cases. J Formos Med Assoc 91:346–350
     [Google Scholar]
  36. Nwiloh J.O., Egbe P.A., Tagoe A.T., Weaver L.W. ( 2000). Staphylococcus aureus pericarditis masquerading as anterior mediastinal mass: mediastinal mass from pericarditis. Chest 118:1832–1833 [CrossRef]
     [Google Scholar]
  37. Pérez‐Cardona J., Salgado V., Medina‐Ruiz A., Quilinchini J., Maldonado A. ( 2008). Pericardial abscess in an intravenous drug user: a case report. P R Health Sci J 27:387–389
     [Google Scholar]
  38. Pond N.E., Humphreys R.J. ( 1952). Blastomycosis with cardiac involvement and peripheral embolization. Am Heart J 43:615–620 [CrossRef]
     [Google Scholar]
  39. Proctor M.E., Davis J.P. ( 1996). Blastomycosis–Wisconsin, 1986–1995. From the Centers for Disease Control and Prevention. JAMA 276:444 [CrossRef]
     [Google Scholar]
  40. Ricketts H.T. ( 1901). A new mould‐fungus as the cause of three cases of so‐called blastomycosis or oidiomycosis of the skin: a preliminary report. J Boston Soc Med Sci 5:453–459
     [Google Scholar]
  41. Ronald S., Strzelczyk J., Moore S., Trepman E., Cheang M., Limerick B., Wiebe L., Sarsfield P., Macdonald K., Meyers M., Embil J.M. ( 2009). Computed tomographic scan evaluation of pulmonary blastomycosis. Can J Infect Dis 20:112–116
     [Google Scholar]
  42. Rose A.S., Knox K.S., Hage C.A. ( 2008). A 24‐year‐old man with mediastinal mass, dyspnea, and a pleural effusion. Chest 134:200–203 [CrossRef]
     [Google Scholar]
  43. Salata R.A. ( 1987). Chronic S aureus pneumonia presenting as mediastinal mass: case report. Va Med 114:473–475
     [Google Scholar]
  44. Schoenbach E.B., Miller J.M., Ginsberg M., Long P.H. ( 1951). Systemic blastomycosis treated with stilbamidine; a preliminary report. JAMA 146:1317–1318 [CrossRef]
     [Google Scholar]
  45. Seitz A.E., Younes N., Steiner C.A., Prevots D.R. ( 2014). Incidence and trends of blastomycosis‐associated hospitalizations in the United States. PLoS One 9:e105466 [CrossRef]
     [Google Scholar]
  46. Sheflin J.R., Campbell J.A., Thompson G.P. ( 1990). Pulmonary blastomycosis: findings on chest radiographs in 63 patients. Am J Roentgenol 154:1177–1180 [CrossRef]
     [Google Scholar]
  47. Shepherd F.J., Rhea L.I. ( 1911). A fatal case of blastomycosis. J Cutan Dis Syph 29:589
     [Google Scholar]
  48. Shersher D.D., Hong E., Breard J., Warren W.H., Liptay M.J. ( 2012). Anterior mediastinal mass secondary to histoplasmosis. Ann Thorac Surg 93:e9–e10 [CrossRef]
     [Google Scholar]
  49. Shojania K.G., Burton E.C. ( 2008). The vanishing nonforensic autopsy. N Engl J Med 358:873–875 [CrossRef]
     [Google Scholar]
  50. Stephany J.D., Lucero S., Walsh A.F. ( 2005). Mediastinal mass in a 27‐year‐old man. Arch Pathol Lab Med 129:699–700
     [Google Scholar]
  51. Sullivan B.J. ( 1993). Epidemiology of blastomycosis in a region of high endemicity in north central Wisconsin. Clin Infect Dis 16:725 [CrossRef]
     [Google Scholar]
  52. Wang X., Zhou T., Deng D., Guo Y. ( 2010). A case of cutaneous nocardiosis with involvement of the trachea, anterior mediastinum and sternum. Case Rep Dermatol 2:177–182 [CrossRef]
     [Google Scholar]
  53. Wiesman I.M., Podbielski F.J., Hernan M.J., Sekosan M., Vigneswaran W.T. ( 1999). Thoracic blastomycosis and empyema. JSLS 3:75–78
     [Google Scholar]
  54. Winer‐Muram H.T., Beals D.H., Cole F.H. ( 1992). Blastomycosis of the lung: CT features. Radiology 182:829–832 [CrossRef]
     [Google Scholar]
  55. Ying W., Sun J., Liu D., Hui X., Yu Y., Wang J., Wang X. ( 2014). Clinical characteristics and immunogenetics of BCGosis/BCGitis in Chinese children: a 6 year follow‐up study. PLoS One 9:e94485 [CrossRef]
     [Google Scholar]
/content/journal/jmmcr/10.1099/jmmcr.0.000022
Loading
Extrapulmonary intrathoracic blastomycosis: a case report and systematic literature review
JMM Case Rep 2, e000022 (2015); https://doi.org/10.1099/jmmcr.0.000022
/content/journal/jmmcr/10.1099/jmmcr.0.000022
/content/journal/jmmcr/10.1099/jmmcr.0.000022
Loading

Data & Media loading...

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An error occurred
Approval was partially successful, following selected items could not be processed due to error