CASE 71

Blastomycosis

QUESTION 71

A 57-year-old woman presents to the dermatology clinic with an indolent painful ulcer on the abdomen. The patient reports associated symptoms of fever, chills, arthralgia, myalgia, night sweats and weight loss. On examination, there is a verrucous plaque with central ulceration and some granulation tissue on the abdomen (71a).

i. Does the cutaneous infection from this dimorphic fungus most commonly represent a primary infection or dissemination from a distant site?

ii. What is the most common primary site of infection?

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