CTICasesDisseminated Blastomycosis
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Imaging findings
The chest radiograph showed diffuse tiny nodules, some bronchial thickening, and a reticulonodular pattern, with micro-nodules. A subsequent CT scan demonstrated numerous random nodules, some larger than typical miliary nodules, consistent with hematogenous dissemination. Given the patient's infectious symptoms, this pattern favored infection over disseminated tumor of hematogenous origin.
Key takeaways
This 53-year-old man initially presented with an ingrown toenail, a possible infection, and partial foot amputation. Weeks later, he developed subcutaneous nodules and had an elevated white count, leading to an extensive workup for a primary source and consideration of Sweet syndrome. After medications ran out, skin lesions reappeared, leading to the chest imaging. Bronchoscopy grew Blastomyces, confirming disseminated blastomycosis. It is unusual for blastomycosis to originate from a skin inoculation (e.g., foot trauma) and then disseminate to the lungs, as the typical route is inhalation of microconidia. The patient, who had no travel history, was treated and showed significant improvement.
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