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Blastomyces dermatitidis is an endemic fungus that frequently infects the skin. Herein, we present a case of disseminated blastomycosis initially misdiagnosed as pulmonary sarcoidosis and cutaneous squamous cell carcinoma.

Report of a Case

A 64-year-old man from New Brunswick, the eastern part of Canada, was referred to the dermatology department for a painless verrucous plaque (3.5 x 1.5 cm) on the helix of his left ear that evolved over the previous 5 months (Figure 1). Squamous cell carcinoma was suggested by initial biopsy findings, which showed pseudoepitheliomatous hyperplasia. On analysis of specimens from a second biopsy, multiple broad-based budding yeasts compatible with B dermatitidis were disclosed under special staining (Figure 2). The diagnosis of cutaneous blastomycosis was further confirmed by positive fungal cultures.

Figure appears in full text version. Figure 1. Left ear lesion.

Figure appears in full text version. Figure 2. Skin biopsy specimen showing epidermal hyperplasia, intraepidermal abscesses, dermal polymorphous infiltrate (hematoxylin-eosin, original magnification x100), and large yeastlike structures . . . [Full Text of this Article]

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AUTHOR INFORMATION
Isabelle Auger, MD; Éric Gagné, MD; Jimmy Alain, MD; René Pelletier, MD