Abstract：
Blastomycosis is a fungal infectious disease that can occur in both immunocompromised and immunocompetent populations endemic in North America, with no previous reports in Japan. A 26-year-old Japanese female patient with no relevant medical history presented intermittent left back pain and an abnormal shadow in the left upper lung field eight months ago at a local clinic. She was referred to our hospital for further evaluation and treatment. The patient currently lives in Japan, but until two years ago had spent several years in New York, Vermont and California. Chest computed tomography revealed a 30 mm mass with a cavity in the left pulmonary apex. The specimens obtained by transbronchial biopsy showed periodic acid-Schiff stain (PAS)-positive and Grocott-positive yeast-like fungi scattered among the granulomas, with no malignant findings, and the initial pathology did not lead to a definitive diagnosis. She was empirically started on fluconazole because of onset of multiple subcutaneous abscesses and was referred to the Medical Mycology Research Center. Although antibody tests could not diagnose the disease, blastomycosis was suspected based on the pathology of the skin and lung tissue at the Medical Mycology Research Center, and Blastomyces dermatitidis was identified by ITS analysis of the rRNA region. Her symptoms and CT findings gradually improved with fluconazole. We reported the first Japanese case of blastomycosis with pulmonary and cutaneous involvement in Japan. As the number of overseas travelers is expected to continue increasing, we would like to emphasize the importance of travel history interviews and information of blastomycosis.
摘要：
芽生菌病是一种真菌传染病，可发生在免疫功能低下和免疫功能正常的人群在北美流行。在日本没有以前的报道。一名没有相关病史的26岁日本女性患者八个月前在当地诊所出现间歇性左背痛和左上肺野异常阴影。她被转诊到我们医院接受进一步的评估和治疗。病人目前住在日本,但直到两年前在纽约呆了几年，佛蒙特州和加州。胸部计算机断层扫描显示30毫米的肿块，左肺心尖有腔。经支气管活检获得的标本显示高碘酸希夫染色（PAS）阳性和Grocott阳性酵母样真菌散布在肉芽肿中，没有恶性发现，最初的病理并没有导致明确的诊断。由于多个皮下脓肿的发作，她在经验上开始使用氟康唑，并被转诊到医学真菌学研究中心。尽管抗体测试不能诊断这种疾病，根据医学真菌学研究中心的皮肤和肺组织的病理学，怀疑有芽生菌病，通过对rRNA区域的ITS分析鉴定了皮肤芽胞菌。氟康唑治疗后症状和CT表现逐渐好转。我们报道了日本首例肺和皮肤受累的胚生菌病。随着海外旅客人数预计将继续增加，我们想强调旅行历史采访和芽生菌病信息的重要性。
