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Jhun, Kim, Park, Yoo, Shim, Kim, Han, and Kwon: A Case of Pulmonary Blastomycosis Mimicking Pulmonary Tuberculosis
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2012; 72(1): 77-81.

Published online: 30 January 2012

DOI: https://doi.org/10.4046/trd.2012.72.1.77

A Case of Pulmonary Blastomycosis Mimicking Pulmonary Tuberculosis

Byung Woo Jhun, M.D.1, Da Min Kim, M.D.1, Ji Hyeon Park, M.D.1, Hong Seok Yoo, M.D.1, Hunbo Shim, M.D.2, Jhin Gook Kim, M.D.2, Joungho Han, M.D., Ph.D.3, O Jung Kwon, M.D., Ph.D.1

1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

2Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

3Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address for correspondence: O Jung Kwon, M.D., Ph.D. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Kangnam-gu, Seoul 135-710, Korea. Phone: 82-2-3410-3421, Fax: 82-2-3410-6956, ojkwon@skku.edu

Received 12 August 2011       Revised 25 August 2011       Accepted 7 September 2011

Copyright © 2012. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Blastomyces dermatitidis is a dimorphic fungus that causes the systemic pyogranulomatous disease known as blastomycosis. Blastomycosis most often involves the lungs, skin, and may involve nearly every organ in the body. It is difficult, however, to diagnose blastomycosis in the early stage of pulmonary disease because clinical manifestations are varied from subclinical infection to acute respiratory distress syndrome. Since blastomycosis is often accompanied by granulomatous inflammation in histopathologic findings, differentiation from other etiologic diseases is important. We report a case of a 45-year-old male with pulmonary blastomycosis who had been misdiagnosed with tuberculosis for 3 months.

Keywords: Blastomycosis, Granuloma, Tuberculosis

Figures and Tables

Figure 1
Posteroanterior chest radiograph showed air-space consolidation with irregular margin in the right upper lung zone.
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Figure 2
(A) Chest computed tomography revealed a low attenuation lesion communicating with the right anterior chest wall, suggestive of empyema necessitatis formation. (B) In the right kidney area a 5 cm size wedge shaped low attenuated lesion was observed.
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Figure 3
Microscopic findings of video-assisted thoracopscopic surgery biopsy showed granulomatous inflammation with a multinucleated giant cell (hematoxylin and eosin stain, ×400).
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Figure 4
(A) Yeast form fungal organisms with a thick cell wall and a single broad-based bud were stained with Gomori methenamine silver stain (Gomori methenamine silver stain, ×400). (B) No highlighting organism was identified with mucicarmine stain (Mucicarmine, ×400).
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Figure 5
Posteroanterior chest radiograph indicated an improved consolidative lesion in the right lung zone after right upper lobectomy and 2 months of itraconazole treatment.
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