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Unusual presentation of more common disease/injury
CASE REPORT
Disseminated blastomycosis presenting as a retro-orbital mass
  1. Shannon Murawski1,
  2. Michael Farrell1,
  3. Fernanda Cordeiro-Rudnisky2 and
  4. Richard Blinkhorn3
  1. 1 Internal Medicine, Albany Medical College, Albany, New York, USA
  2. 2 Pathology, Albany Medical College, Albany, New York, USA
  3. 3 Internal Medicine and Infectious Disease, Albany Medical College, Albany, New York, USA
  1. Correspondence to Dr Shannon Murawski, murawss{at}amc.edu

Abstract

A 43-year-old man with history of non-Hodgkins’ lymphoma presented with unilateral eye swelling, pain and vision deficits which had been progressive over 2 months. Symptoms followed a presumed bacterial pneumonia 4 months prior. Imaging demonstrated retro-orbital soft tissue swelling with bony erosion concerning for a mass; surgical decompression was performed with histology confirming disseminated Blastomyces dermatitidis. Symptoms responded rapidly to antifungal therapy with amphotericin followed by itraconazole. Orbital dissemination of blastomycosis is extremely rare; accurate diagnosis requires tissue biopsy to facilitate timely targeted therapy and minimise morbidity.

  • infectious diseases
  • TB and other respiratory infections
  • ophthalmology
  • pathology

https://doi.org/10.1136/bcr-2018-228681

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    Footnotes

    • Contributors All authors were involved in management of the case. SM, MF and RB participated in planning, writing and editing of the final manuscript. FC-R assisted with pathology image acquisition and interpretation.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.