DISSEMINATED BLASTOMYCOSIS AND ACQUIRED-IMMUNODEFICIENCY-SYNDROME - ACASE-REPORT AND ULTRASTRUCTURAL-STUDY

A 42-year-old, African-American man presented with a 2-month history o f weight loss and fever for 2 weeks. Presumptive diagnoses of human im munodeficiency virus infection(HIV) and acquired immunodeficiency synd rome were made on the basis of a CD4 lymphocyte count of 23 lymphocyte s/mL. Chest x-ray revealed right paratracheal adenopathy and a miliary pattern. The etiology of the patient's pulmonary infection was not kn own, but tuberculosis was an important consideration. Over 5 days, the pulmonary infection progressed and was complicated by acute respirato ry distress syndrome (ARDS), septic shock, and death, despite vigorous antibiotic and supportive therapy. Serologic tests for HIV infection were reported as positive after the patient's demise. The-etiology of the patient's pulmonary infection, ARDS, and sepsis was not known unti l autopsy study revealed enumerable yeast-like cells of Blastomyces de rmatitidis in the extensively consolidated lungs and in disseminated f oci of infection in most other major organs. Diffuse alveolar damage w as closely associated with the pulmonary blastomycosis. Electron micro scopic study of the yeast-like cells of B. dermatitidis in the autopsy lung obtained and fixed 5 days after the patient's death revealed exc ellent preservation of viable organisms.