Primary cutaneous blastomycosis is a rare presentation of infection caused by direct inoculation of a wound. We present a 61-year-old male with an extensive history of wound dehiscence and wound care noncompliance after a bite from a brown recluse spider on the left thigh while on vacation in Cape Cod in September of 2020. After antibiotic therapy and culture, treatment involved debridement, split thickness skin grafting, strict wound vacuum-assisted closure care, and oral itraconazole. This brief demonstrates a case of blastomycosis arising from trauma in a non-endemic region for infection and serves as an example of successful management of the longstanding wound.
OwenWRThursKKimDSL. Blastomycosis presenting as a nonhealing wound. Adv Skin Wound Care. 2012;25:321–323. doi:10.1097/01.ASW.0000416005.78089.b0
2.
ChapmanSWDismukesWEProiaLA,et al.Clinical practice guidelines for the management of blastomycosis: 2008 update by the infectious diseases society of America. Clin Infect Dis. 2008;46:1801–1812. doi:10.1086/588300
3.
MotswalediHMMonyemangeneFMMalobaBRNemutavhananiDL. Blastomycosis: a case report and review of the literature. Int J Dermatol. 2012;51:1090–1093.
4.
LadizinskiBJoyNReidDC. Primary cutaneous blastomycosis after inoculation from a woodworking blade. J Emerg Med. 2018;54:e11–e12. doi:10.1016/j.jemermed.2017.09.034.
5.
WilsonJWAngelesLCawleyPFredDGilWS. Primary cutaneous North American blastomycosis. Arch Dermatol. 1955;71:39–45.
6.
Ortega-LoayzaAGNguyenT. Cutaneous blastomycosis: a clue to a systemic disease. An Bras Dermatol. 2013;88:287–289.
7.
AghaRAFowlerAJSaetaA, et al.The SCARE statement: Consensus-based surgical case report guidelines. Int J Surg. 2016;34:180–186. 10.1016/J.IJSU.2016.08.014
ElmasÖFUyarBKilitçiA. A 25-year history of leg ulceration: cutaneous blastomycosis. Dermatol Pract Concept. 2020;10:e2020054. doi:10.5826/dpc.1003a54
10.
ZhuDChenHYuL. International journal of infectious diseases probable pulmonary blastomyomycocis in an immunocompetent person. Int J Infect Dis. 2017;59:86–89. doi:10.1016/j.ijid.2017.04.006
WangSMartiniMCGrothJVHernandezC. Dermatoscopic and clinicopathologic findings of cutaneous blastomycosis. J Am Acad Dermatol. 2015;73:e169–e170. doi:10.1016/j.jaad.2015.07.024
13.
Fernandez-FloresASaeb-LimaMArenas-GuzmanR. Morphological findings of deep cutaneous fungal infections. Am J Dermatopathol. 2014;36:531–556. doi:10.1097/DAD.0b013e31829cc6f3
14.
BlumePAKeyJJThakorPThakorSSumpioBBlumePA. Retrospective evaluation of clinical outcomes in subjects with split-thickness skin graft: Comparing V.A.C. Therapy and conventional therapy in foot and ankle reconstructive surgeries clinical outcomes in subjects with split-thickness skin graft. Int Wound J. 2010;7:480–487.
15.
TangXGuoPWongH,et al.Vacuum-Assisted closure and skin grafting combined with amphotericin B for successful treatment of an immunocompromised patient with cutaneous mucormycosis caused by Mucor irregularis: A case report and literature review. Mycopathologia. 2021;186:449–459. doi:10.1007/S11046-021-00551-3
16.
LeclercqALabeilleBPerrotJLVercherinPCambazardF. Skin graft secured by VAC (vacuum-assisted closure) therapy in chronic leg ulcers: A controlled randomized study. Ann Dermatol Venereol. 2016;143:3–8. doi:10.1016/J.ANNDER.2015.06.022
