Respiratory failure due to blastomycosis infection in a patient with hypertension, cirrhosis and chronic pancreatitis

Abstract

Blastomycosis is an endemic fungal infection in North America. It usually causes acute and occasionally chronic pneumonias with disseminated infection, particularly skin lesion, as an extrapulmonary manifestation. Many cases are asymptomatic; however, a few patients progress to develop severe pulmonary infection leading to acute respiratory distress syndrome, which carries a high mortality rate. Disseminated blastomycosis involving the heart is exceptionally rare and can be potentially life threatening. To our knowledge, there are only four reported cases of cardiac blastomycosis in the literature. Here, we report a case of cardiac blastomycosis who initially presented with respiratory failure. In our patient, it was practically impossible to establish a diagnosis of cardiac blastomycosis antemortem because of his previous cardiac history related to alcoholic cardiomyopathy, which confounded the cardiac findings. This case raises an important issue of clinically considering involvement of the heart in cases of disseminated blastomycosis. Perhaps if the patient did not have a prior cardiac history, a new onset heart failure may have suggested cardiac involvement.

Keywords::

• disseminated blastomycosis
• fungal infection
• heart failure
• respiratory failure

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • In patients with respiratory failure and extra-pulmonary manifestations disseminated blastomycosis should be considered in the differential diagnosis especially in endemic areas.

• • Cardiac blastomycosis is a rare complication of disseminated blastomycosis; however, should be considered in the differential if there is cardiac failure.

• • Treatment should be individualized based on the clinical presentation, where mild to moderate diseases can be treated with oral itraconazole, while severe cases should be treated with intravenous amphotericin.