A CASE OF BLASTOMYCOSIS

T. H. BOUGHTON
1914 Archives of Internal Medicine  
Case XXIII (5).\p=m-\History.\p=m-\J.C., man, aged 21, entered Cook County Hospital, Aug. 21, 1907, to the orthopedic service of Dr. E. W. Ryerson. He was born in Italy, moved to the United States at the age of 1 year, and lived in Chicago since. He went to work at the age of 14, and has been engaged in peddling and factory work. For several months previous to his illness he worked in a tobacco factory and inhaled considerable tobacco dust. He also chewed considerable tobacco while in the
more » ... while in the factory. When at home he lived under fair hygienic conditions, but during the fall preceding the onset of the disease, after getting into trouble and being expelled from home, he slept in exposed outbuildings and basements. The previous and family history are unimportant. He caught cold Nov. 15, 1906, and was confined to the house for two weeks, coughing frequently and expectorating bloody sputum at this time. He went to work December 1, and noticed pain in back of neck, and in right side of chest, and was obliged to stop work in a few days because of weakness, especially in the left arm, and was then confined to bed until December 27. At this time he suffered with pain in the back, bloody expectoration and night sweats. After January 1 he improved sufficiently to go to work, but, owing to weakness, was again obliged to return to his home, where he remained for the next five months. He coughed, expectorated bloody sputum, suffered pain in back and was quite weak. On May 30 he fell and hurt his back. From that time urination and defecation were involuntary. Two days after the fall he came to the hospital, complaining of pain in side, which was strapped, and he returned home, but the pain persisted for two weeks. On July 1 he Avas sent to Dunning, Avhere he remained for one month in the tuberculosis hospital; íaao A\;,eeks of this time he AA'as in bed. On August 21, as previously stated, he entered the hospital complain¬ ing of painful cough, weakness of the legs and im-oluntary evacuations. A kyphosis at the level of the second dorsal A'ertebra Avas noticed at this time, and in the examining-room the disease Avas considered tuberculosis of the lungs and spine. Three Aveeks after entering the hospital (September 15), he fell Avhile Avalking about the ward, and Avas thereafter unable to walk, owing to partial paralysis, and about one month later the paralysis of the legs became complete. Sensa¬ tion Avas much diminished in the legs, but Avas never completely lost. The kneejerks Avere increased; ankle-clonus and Babinski's sign also Avere present. Up to this time the diagnosis of tuberculosis had not been questioned, but the failure to find the tubercle bacilli in the sputum, together with the presence of numerous cutaneous lesions, gave rise to suspicions of blastomycosis. Examination of the unstained sputum and pus from various abscesses Avas undertaken Avith the result, at this time quite surprising to us, that the organisms Avere found quite abundantly present in both. Examination.-An examination about December 1 revealed the following con¬ ditions: The patient lies quietly, seems comfortable, is unable to move the lower, and experiences some pain on motion of the upper extremities. Emaciation is marked and the skin is harsh and dry. He coughs occasionally and expectorates a purulent blood-tinged sputum. The A'oice is husky and evacuations are involun¬ tary. On the left cheek near the nose is a dull red, slightly indurated, sharply outlined, flat crusted area, 2.5 cm. in diameter, marking the rupture of an abscess, part of Avhich remains as a slightly red fluctuating mass, about 3 cm. in length,
doi:10.1001/archinte.1914.00070100087006 fatcat:bcse353ncjhkpkaogg4dxasnie