CTICasesBlastomycosis Presenting as Necrotizing Pneumonia
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Imaging findings
A chest radiograph shows patchy consolidation and a large mass bulging on the right upper lobe fissure. CT shows a dense area of consolidation with cavitation, appearing boggy. Few small scattered nodules are noted, but there is no pleural effusion and minimal lymphadenopathy.
Key takeaways
Blastomycosis can present as necrotizing pneumonia, often without significant pleural effusions or lymphadenopathy. Diagnosis can be challenging, requiring culture, antigen testing (urinary antigen, cross-reacts with histoplasmosis), or microscopy of bronchoalveolar lavage fluid. Treatment often involves voriconazole, itraconazole, or amphotericin for disseminated cases. It is typically inhaled as a spore and can disseminate widely to sites like the central nervous system and bone.
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