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North American Blastomycosis. Presented by William Bailey, MD, and Marvin Klapman, MD.
This 41-year-old white man has a six-month history of lesions on his neck, right hand, left wrist, and left knee, which first appeared while he was a patient in a tuberculosis sanitarium. At that time Mycobacterium tuberculosis was cultured from gastric washings and an upper left lung lobectomy was performed. He has been on a regimen of isoniazid, 300 mg a day, since June 1966.
The patient is a thin white man with hyperkeratotic verrucose lesions, with violaceous indurated margins on the neck, right hand, left wrist, and left knee.
Complete blood cell count (CBC), blood urea nitrogen (BUN), creatinine, serology, and potassium values, and liver profile were within normal limits. Urinalysis revealed 8 to 10 white blood cells (WBCs) per high power field. Urine culture showed no growth. Creatinine clearance was 64.5 cc
Becker SW, Haeberlin JB. CHICAGO DERMATOLOGICAL SOCIETY. Arch Dermatol. 1967;96(6):728-738. doi:10.1001/archderm.1967.01610060122025