an interesting case

History: 40y/o previously healthy male presented to ER with fever, shortness of breath for three weeks.

I will not claim the diagnose right now, but I am posting the related pictures here, welcome to have a guess. :D

Medicine is fun!

Answer:

Blastomycosis! You guys are great, I am very impressed.:D

Some quick knowledge:

The endemic area in North America includes the southeastern and south central states, especially those bordering the Mississippi and Ohio River basins. Most cases are reported in Mississippi, Arkansas, Kentucky, Tennessee, and Wisconsin. A large outbreak was reported in Wisconsin with isolation of Blastomyces Dermatitidis in the soil at a beaver dam.

Initial analysis of sporadic cases indicated that middle-aged men with outdoor occupations that exposed them to soil were at greatest risk for blastomycosis.

Pulmonary manifestations are the most common clinical presentation of Blastomycosis. The skin, bones, and genitourinary systems are the most frequent extrapulmonary systems involved with this entity.

In this case, chest CT scan shows a dense left lower lobe infiltrate with central cavities. Diagnosis was established by BAL culture. Histopathology revealed broad-based budding yeasts, and cultures were positive for Blastomyces dermatitidis.

Treatment options for Blastomycosis include Itraconazole (mild to moderate disease) and Amphotericin B (life-threatening disease). Treatment duration varies from 6 months to 1 year.

Reference:
Mandell, Bennett, & Dolin: Principles and Practice of Infectious Diseases, 6th ed.



谢谢同学们的参与，之所以觉得有趣，是因为感觉这个病例让我深切体会到自然与人的密切联系。

美丽的大湖上，有一群天生的建筑师，水獭，他们日复一日，辛勤地建立自己的宫殿。在那些腐木，土壤之中，无声地生长着原始的真菌，这种真菌有两种面貌，它们在低温下有着细长分支，养成孢子，在空气中播散，在温暖的环境下，就会变成圆球状的酵母，不停地分裂繁殖。

大湖，水獭，真菌，千百年来息息共存，直到有一天，人类不停地扩展他们的领域，终于进入了这个稳定的生态小圈子。人们进入大湖捕鱼，呼吸到了水獭被迫废弃的宫殿中播散的真菌孢子，孢子进入温暖的人体环境，变成酵母，开始繁殖，这就是上面图中那个正在分裂成两个圆球的真菌。

总是在想，水獭自己是不是也会生这种真菌肺炎呢？还是只有我们人类？原本不属于那个生物圈里的种群，才会得病？

自然的奥秘，总是让人欲罢不能。

[静水苍兰]

哦, 谢谢.获益良多

[冰天雪地一萝卜]

肺浸在水里面，胸膜炎之类？？不过这个回答不够FUNNY...

[undemi]

beaver fever, you must be in Wisconsin

[3yearsflies]

Blastomycosis. What area of the country did you find this patient? What's his HIV status?

You are really pretty! It's your best photo I've seen so far.

BTW, any prize for the winner?

[飞舞的蒲公英]

pulmonary cryptococcosis?

[Dalaoshu]

en, must be blastomycosis! that's why there is a lovely beaver and his dam, isn't it?
""the diagnosis of blastomycosis can usually be confirmed by demonstration of the characteristic broad based budding organisms in sputum or tissues by KOH prep, cytology, or histology. ""-----from answers.com

so what's on the CXR? diffuse pulmonary infiltrates?

[Dalaoshu]

Pneumothorax+ fluid on the other side?
no idea for the etiology. maybe like happyjia said, blastomycosis?
:)

[happyjia]

It seems like fungus infection,such as Blastomycosis.
^^

[追梦夏威夷]

气胸？

[落花飘零]

you are so quick!
very good thought. it is an animal related disease just like SARS does. but this case is not SARS.
i will give the answer by the weekend. hehe.

[静水苍兰]

我不是医生,纯粹一外行.

怎么感觉你的图片在暗示与SARS有关?

但如果是FUNNY的话,正确答案应不是这个.期待ING