Cutaneous Blastomycosis

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Blastomycosis is an uncommon but well known chronic infectious disease produced by budding yeast-like organisms commonly grouped as blastomycetes. North American, South American, and European types have been described. Although the botanical classification of the various organisms producing the protean forms of the disease has not yet been clarified, a more recent and probably correct term for the causative organism of the North American type is Zymonema dermatitidis (blastomyces dermatitidis), for the South American types (paracoccidioidal granuloma) P. braziliensis, P. cerebriforme, and P. tenui (B. braziliensis), and for European blastomycosis, cryptococcus neoformans.1 Since the latter two types do not originate in the United States this paper is concerned only with the North American type, under which the 2 cases herein described fall.

North American blastomycosis, as well as the other two types, occurs in two forms, systemic and cutaneous. Cutaneous lesions appear in 95 per cent of cases of the systemic form. A brief description of the clinical manifestations of the systemic form will bring into sharp relief those of primary cutaneous blastomycosis as exemplified by one of our 2 cases. The cutaneous lesions in systemic blastomycosis are probably hemato-genous in origin, as they appear in successive crops of subcutaneous nodules and abscesses with subsequent development into ulcers having a purulent discharge. They tend to be disseminated on the unexposed parts such as the back, abdomen, and thighs, although the face and extremities may be involved.

In the cutaneous form the sites of predilection are the exposed surfaces, head, and. . .



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