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Blastomycosis and Pregnancy: An Unusual Postpartum Disease Course.

Surprenant D, Kaniszewska M, Hutchens K, Go C, O'Keefe P, Swan J, Tung R - Case Rep Dermatol (2015)

Bottom Line: The partial immunosuppressive state induced by pregnancy can engender more severe infections and is associated with a risk of vertical transmission.At 6 weeks postpartum she was treated with oral itraconazole and demonstrated clinical improvement after 5 months of therapy.This case highlights the importance of prompt disease recognition, understanding of risk factors and initiation of appropriate antifungal therapy of blastomycotic infection occurring in the unique setting of pregnancy.

View Article: PubMed Central - PubMed

Affiliation: Divisions of Dermatology, Loyola University Medical Center, Maywood, Ill., USA.

ABSTRACT
Blastomyces dermatitidis is responsible for systemic mycoses. It is predominantly caused by inhalation of spores and often manifests as pneumonia, which can potentially disseminate; however, direct cutaneous inoculation may also occur. Blastomycosis in the perigravid period is exceedingly rare. The partial immunosuppressive state induced by pregnancy can engender more severe infections and is associated with a risk of vertical transmission. Published cases describe postpartum symptomatic improvement accompanying immune reconstitution, even in the absence of treatment. We present a 31-year-old gravid female with multifocal cutaneous blastomycosis. After delivering a healthy full-term infant with no evidence of congenital infection, the patient's cutaneous lesions continued to worsen. At 6 weeks postpartum she was treated with oral itraconazole and demonstrated clinical improvement after 5 months of therapy. This case highlights the importance of prompt disease recognition, understanding of risk factors and initiation of appropriate antifungal therapy of blastomycotic infection occurring in the unique setting of pregnancy.

No MeSH data available.


Related in: MedlinePlus

a, b Pseudoepitheliomatous hyperplasia with underlying abscess formation (a, ×200), with rare B. dermatitidis yeast forms highlighted by Grocott-Gomori methenamine silver stain (b, ×600). c Focal granuloma formation with central abscess (×400).
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Figure 2: a, b Pseudoepitheliomatous hyperplasia with underlying abscess formation (a, ×200), with rare B. dermatitidis yeast forms highlighted by Grocott-Gomori methenamine silver stain (b, ×600). c Focal granuloma formation with central abscess (×400).

Mentions: Biopsy and tissue cultures were performed. Histological analysis revealed pseudoepitheliomatous hyperplasia with underlying dense superficial and deep mixed cell infiltrate composed of neutrophils, lymphocytes, histiocytes and multinucleated giant cells (fig. 2a). A few scattered round to oval organisms with refractile cell walls in the cytoplasm of giant cells, consistent with B. dermatitidis, highlighted by Grocott-Gomori methenamine silver stain, were identified (fig. 2b). Well-formed necrotizing granulomas and large neutrophilic abscesses, consistent with fungal infection, were readily identifiable (fig. 2c). Fungal culture grew B. dermatitidis, which was confirmed by DNA probe.


Blastomycosis and Pregnancy: An Unusual Postpartum Disease Course.

Surprenant D, Kaniszewska M, Hutchens K, Go C, O'Keefe P, Swan J, Tung R - Case Rep Dermatol (2015)

a, b Pseudoepitheliomatous hyperplasia with underlying abscess formation (a, ×200), with rare B. dermatitidis yeast forms highlighted by Grocott-Gomori methenamine silver stain (b, ×600). c Focal granuloma formation with central abscess (×400).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4478327&req=5

Figure 2: a, b Pseudoepitheliomatous hyperplasia with underlying abscess formation (a, ×200), with rare B. dermatitidis yeast forms highlighted by Grocott-Gomori methenamine silver stain (b, ×600). c Focal granuloma formation with central abscess (×400).
Mentions: Biopsy and tissue cultures were performed. Histological analysis revealed pseudoepitheliomatous hyperplasia with underlying dense superficial and deep mixed cell infiltrate composed of neutrophils, lymphocytes, histiocytes and multinucleated giant cells (fig. 2a). A few scattered round to oval organisms with refractile cell walls in the cytoplasm of giant cells, consistent with B. dermatitidis, highlighted by Grocott-Gomori methenamine silver stain, were identified (fig. 2b). Well-formed necrotizing granulomas and large neutrophilic abscesses, consistent with fungal infection, were readily identifiable (fig. 2c). Fungal culture grew B. dermatitidis, which was confirmed by DNA probe.

Bottom Line: The partial immunosuppressive state induced by pregnancy can engender more severe infections and is associated with a risk of vertical transmission.At 6 weeks postpartum she was treated with oral itraconazole and demonstrated clinical improvement after 5 months of therapy.This case highlights the importance of prompt disease recognition, understanding of risk factors and initiation of appropriate antifungal therapy of blastomycotic infection occurring in the unique setting of pregnancy.

View Article: PubMed Central - PubMed

Affiliation: Divisions of Dermatology, Loyola University Medical Center, Maywood, Ill., USA.

ABSTRACT
Blastomyces dermatitidis is responsible for systemic mycoses. It is predominantly caused by inhalation of spores and often manifests as pneumonia, which can potentially disseminate; however, direct cutaneous inoculation may also occur. Blastomycosis in the perigravid period is exceedingly rare. The partial immunosuppressive state induced by pregnancy can engender more severe infections and is associated with a risk of vertical transmission. Published cases describe postpartum symptomatic improvement accompanying immune reconstitution, even in the absence of treatment. We present a 31-year-old gravid female with multifocal cutaneous blastomycosis. After delivering a healthy full-term infant with no evidence of congenital infection, the patient's cutaneous lesions continued to worsen. At 6 weeks postpartum she was treated with oral itraconazole and demonstrated clinical improvement after 5 months of therapy. This case highlights the importance of prompt disease recognition, understanding of risk factors and initiation of appropriate antifungal therapy of blastomycotic infection occurring in the unique setting of pregnancy.

No MeSH data available.


Related in: MedlinePlus