Pulmonary Blastomycosis: A Report of a Case Treated with 2-Hydroxystilbamidine
WILLIAM J. STAAB, M.D.
Division of Medicine
HOWARD S. VAN ORDSTRAND, M.D.
Department of Pulmonary Disease
NORTH American blastomycosis may exist as a cutaneous or a systemic disease. In the systemic form the organs most frequently affected are the lungs and the bones; however, other organs are affected in a significant number of cases.1 The disease may have many and bizarre manifestations and has even been reported as having simulated multiple myeloma, with an increase of plasma cells in the bone marrow.2 The epidemiology is poorly understood and no definite conclusions as to the reservoir or mode of transmission have been established. It is believed that the causal organism, a fungus, resides in moist soil and that humans contract the systemic type of blastomycosis by inhalation, and the cutaneous type by primary inoculation of exposed surfaces.3–5
It was previously thought that the cutaneous form was more prevalent, but in a recent series of 40 patients only four had isolated skin lesions.2 The most frequent symptoms were cough, hemoptysis, expectoration, and fever. Our report is of a case of pulmonary blastomycosis in which the primary symptom was fever, and which was complicated by chest pain and hemoptysis secondary to a pulmonary embolus.
Report of a Case
History. A 46-year-old man, an office worker from southwestern Ohio, was admitted to the Cleveland Clinic Hospital on January 21, 1957, with a chief complaint of fever of about one month’s duration. In November, 1956, he had a fever of short duration associated with a sore throat, which responded to penicillin. He again had a sore throat and fever in. . .