BLASTOMYCOSIS IN IMMUNOSUPPRESSED PATIENTS

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Abstract
Of 78 patients with blastomycosis, 3 had received glucocorticoid therapy prior to diagnosis and 3 others had an underlying hematologic malignancy (chronic lymphocytic leukemia, chronic myelogenous leukemia, multiple myeloma). The clinical picture in these 6 patients was similar to blastomycosis in nonimmunosuppressed patients (in contrast to histoplasmosis of coccidioidomycosis in immunosuppressed patients in whom a distinct clinical syndrome is often seen). The patients presented with chronic pulmonary infiltrates or isolated skin ulcers. The response to therapy was good if the diagnosis was made early. Blastomycosis can occur in immunosuppressed patients. The spectrum of underlying illness is not seen in opportunistic histoplasmosis or coccidioidomycosis where patients with T cell defects predominate. Possible explanations for the rarity of blastomycosis in more classically T cell-immununosuppressed patients are discussed.

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