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Clinical Problem Solving: Pathology
June 2012

Pathology Quiz Case 2: Diagnosis

Arch Otolaryngol Head Neck Surg. 2012;138(6):606-607. doi:10.1001/archoto.2012.504b

Final cultures from the abscess, bronchoalveolar lavage, and chest mass all revealed Blastomyces dermatitidis. The yeast form seen in Figure 3 reveals the distinctive features of B dermatitidis, including the thick wall, spherical shape, and a budding daughter cell that is the same size as the mother cell and is undergoing base narrowing before its detachment. The patient was placed on an oral regimen of itraconazole (200 mg/d) for a 1-year period. Shortly after this therapy was initiated, his white blood cell count normalized. The neck abscess did not reaccumulate after percutaneous drainage.

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