MAJOR ARTICLE: Cutaneous Inoculation Blastomycosis

Abstract

Cutaneous inoculation blastomycosis is a rare illness. We report a case of cutaneous inoculation blastomycosis in a patient who was inoculated after being struck by a projectile while performing yard work. We also review cases of cutaneous inoculation blastomycosis described elsewhere, to improve characterization of the syndrome. Blastomycosis is caused by infection with the dimorphic fungus Blastomyces dermatitidis. Primary infection initially involves the lungs, and it can subsequently he-matogenously disseminate to extrapulmonary sites. Cases of cutaneous blastomycosis usually originate from a pulmonary site, regardless of whether pulmonary infection was clinically apparent. In rare cases, cutaneous inoculation with B. derma-titidis can cause a syndrome of cutaneous inoculation blastomycosis. We report a case of cutaneous inoculation blastomycosis and review the medical literature for additional cases, to improve characterization of the illness. CASE REPORT A 28-year-old, previously healthy man was struck on the right cheek by a rock thrown from a lawn-mowing tool 3 weeks before admission to the hospital. Initially, the patient noticed a dark, discolored lesion on his right cheek. Later, he developed redness in the area and a "scab." Approximately 1 week after the injury occurred, the patient noted painful swelling of the right side of his neck. He sought care from his primary care phy