Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a subacute to chronic respiratory illness characterized by productive cough, pleuritic chest pain, and dyspnea. Associated systemic symptoms include low-grade fever, night sweats, weight loss, and fatigue. History of potential environmental exposure in endemic regions (e.g., Ohio/Mississippi River valleys, Great Lakes) noted. No response to standard community-acquired pneumonia antibiotic regimens.
Clinical Examination Findings
General: Patient appears chronically ill, cachectic. HEENT: Possible cutaneous lesions (verrucous or ulcerated plaques) noted on face or extremities. Respiratory: Auscultation reveals localized or diffuse crackles, bronchial breath sounds, or signs of consolidation. Dullness to percussion noted in affected lung fields. Skin: Careful inspection for papules, pustules, or nodules suggestive of disseminated disease.
Treatment Protocol
Initiate antifungal therapy based on disease severity. Mild to moderate pulmonary blastomycosis: Itraconazole 200 mg orally 2-3 times daily for 6-12 months. Severe or life-threatening disease: Initial stabilization with intravenous Amphotericin B (Liposomal formulation preferred) followed by step-down to oral Itraconazole. Monitor liver function tests and serum drug levels periodically.