P207 A rare case of disseminated Blastomycosis in an immunocompetent host: A report from North India
Bibliographic record
Abstract
Abstract Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objectives Blastomycosis is a serious life-threatening systemic infection caused by dimorphic fungi Blastomyces dermatitidis. Infection is acquired via inhalation of airborne conidia or traumatic inoculation. It may produce a spectrum of infections ranging from asymptomatic infections in immunocompetent patients to disseminated disease, including skin, bone, genitourinary tract, and central nervous system (CNS) involvement in immunocompromised patients. This fungal infection is very rare in India. We report a unique case of disseminated blastomycosis in an immunocompetent patient. Methods A 37-year-old male patient from Kanpur, Uttar Pradesh presented with chief complaints of hematuria associated with passage of blood clots for 3 months. There was no history of dysuria, fever, or pain abdomen. When he was evaluated for gross hematuria, his USG abdomen was suggestive of bilateral renal masses. To rule out bilateral renal cell carcinoma an FDG pet scan was done which was suggestive of FDG avid lesions in the bilateral kidneys. He also had enlarged left supraclavicular and left cervical lymph nodes. Multiple nodular and verrucous lesions were seen all over the face. He complained of pain in the left ankle; with a small wound opening on the medial malleolus of the left ankle. Results A skin biopsy was taken from one of the nodular and verrucous lesions over face. A total of 10% wet mount KOH preparation shows no epithelial cells, plenty of pus cells, no RBCs, and plenty of thick-walled round yeasts and some with broad-based budding yeasts (8-12 microns) suggestive of Blastomyces species. Renal abscess pus FNAC, left cervical lymph node, and CT-guided biopsy from the medial malleolus of the left ankle also showed similar round yeasts and some with broad-based budding suggestive of Blastomyces species. Hence, a preliminary diagnosis of disseminated blastomycosis was made. Cultures were put in SDA at 25°C and 37°C and after a week, colonies appeared as fluffy white glabrous with reverse cream-colored non-sporulating colony. On day 25, colony appears as tan glabrous fluffy with brownish reverse with sporulation. LPCB was done from the colony which showed thin septate hyphae with pedunculated and sessile spherical to pyriform and smooth walled microconidia suggestive of Blastomyces dermatitidis. He was started on IV liposomal amphotericin B for 20 days. HCV RNA was detected incidentally and he had transaminitis therefore, he could not be started on itraconazole, he was started on fluconazole. His facial lesions cleared dramatically; his left ankle pain and swelling had resolved. At present, he was symptomatically better and was discharged on 200 mg fluconazole once daily and advised for follow-up after 2 weeks. Conclusion Blastomycosis is a relatively uncommon geographically restricted chronic granulomatous disease that mainly occurs in the endemic regions. This fungus lives primarily in moist soil and decomposing matter, and inhabits the mid-west, south-central, southeastern United States as well as the boreal forests of Ontario and Quebec in Canada. Very little is known about the natural habitat and environmental distribution of Blastomyces species in India. This case is unique because the patient is immunocompetent and has no history of travel outside of India.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".