A case of disseminated blastomycosis with pulmonary, genitourinary, and osteoarticular involvement in southern Saskatchewan

Abstract

Although southern Saskatchewan is not known to be a region endemic to blastomycosis, we present a case of disseminated blastomycosis in a 39-year-old man with pulmonary, genitourinary, and osteoarticular involvement. The patient presented with persistent fevers despite recent antibiotic therapy, arthritis in his left foot, and urinary obstruction. A computed tomography (CT) scan of the chest revealed a diffuse miliary pattern. A transbronchial biopsy only showed granulomatous changes, and washings were negative for fungal culture. Magnetic resonance imaging (MRI) of the left foot revealed signs of septic arthritis. Pathology from the joint aspiration and debridement revealed budding yeast in keeping with blastomycosis. Urine culture also grew blastomycosis, confirming urinary involvement. He was initiated on itraconazole, with complete resolution of his symptoms within 2 weeks. This case illustrates the challenges in diagnosing disseminated blastomycosis, and further establishes the endemicity of blastomycosis in southern Saskatchewan.