1999 Resident Poster Competition
Roshan Kothandaram M.D.
St. Mary's Medical Center
Blastomycosis Presenting as Lobar Consolidation in an Immunocompetent Host
Blastomycosis is a rare cause of pneumonia in an immunocompetent host. A 33 year old, immunocompetent, Caucasian male developed consolidation of his right upper lobe. Patient failed to respond to multiple courses of antibiotics over a 3 week period. A repeat chest x-ray was unchanged. A CT Scan of the chest confirmed consolidation in the right upper lobe. PPD was negative, as was HIV serology. A CD4 T cell count was increased at 1,962. A CT guided biopsy of the lesion showed budding yeast which was shown on culture to be blastomyces. He was initially treated with Amphotericin B but developed rapid nephrotoxicity prompting a change to oral Itraconazole 400 mg po daily which he tolerated well. Subsequent testing of the isolate demonstrated susceptibility to both Amphotericin B and Itraconazole. He improved steadily and treatment was continued for 1 year. A chest x-ray at that time showed only RUL residual fibrosis. Fungal pneumonias may mimic bacterial pneumonias. Lobar consolidation unresponsive to antibacterial therapy should lead to an aggressive diagnostic approach.
Return to 1999 Table of Contents
What's New
Contact Information
Alan D Forker, MD MACP
Missouri Chapter Governor
Patrick Mills
Missouri Chapter Executive Director
