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.



謝謝同學們的參與，之所以覺得有趣，是因為感覺這個病例讓我深切體會到自然與人的密切聯係。

美麗的大湖上，有一群天生的建築師，水獺，他們日複一日，辛勤地建立自己的宮殿。在那些腐木，土壤之中，無聲地生長著原始的真菌，這種真菌有兩種麵貌，它們在低溫下有著細長分支，養成孢子，在空氣中播散，在溫暖的環境下，就會變成圓球狀的酵母，不停地分裂繁殖。

大湖，水獺，真菌，千百年來息息共存，直到有一天，人類不停地擴展他們的領域，終於進入了這個穩定的生態小圈子。人們進入大湖捕魚，呼吸到了水獺被迫廢棄的宮殿中播散的真菌孢子，孢子進入溫暖的人體環境，變成酵母，開始繁殖，這就是上麵圖中那個正在分裂成兩個圓球的真菌。

總是在想，水獺自己是不是也會生這種真菌肺炎呢？還是隻有我們人類？原本不屬於那個生物圈裏的種群，才會得病？

自然的奧秘，總是讓人欲罷不能。

[靜水蒼蘭]

哦, 謝謝.獲益良多

[冰天雪地一蘿卜]

肺浸在水裏麵，胸膜炎之類？？不過這個回答不夠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?

[飛舞的蒲公英]

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.
^^

[追夢夏威夷]

氣胸？

[落花飄零]

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.

[靜水蒼蘭]

我不是醫生,純粹一外行.

怎麽感覺你的圖片在暗示與SARS有關?

但如果是FUNNY的話,正確答案應不是這個.期待ING