Blastomycosis of the head and neck

BackgroundBlastomyces dermatitidis infection of head and neck structures is a rare clinical entity. However, the potential for significant morbidity warrants clinical consideration and timely diagnosis.Objective of reviewTo describe the clinical presentations, diagnostic challenges, and outcomes of otolaryngologic blastomycosis.Search strategyA literature search of the Pubmed and Ovid databases with the terms “blastomycosis AND. . . “ followed by all terms related to anatomical regions of the head and neck.Evaluation methodAll publications which discussed pertinent otolaryngologic involvement from blastomycotic infections were evaluated.Results and conclusionThe larynx was the most commonly reported site of infection, followed by the oral cavity, neck, ear, nasal cavity/paranasal sinuses, and skull base/orbit/calvarium. Diagnosis of blastomycosis was almost universally delayed due to the resemblance of presentation to more common clinical entities, most notably squamous cell carcinoma. A substantial portion of cases (42%) presented without clinical or radiographic evidence of pulmonary infection. The initial diagnostic confusion often resulted in disease progression and trials of invasive therapies. Most patients experienced complete resolution of symptoms and lesions within months of initiation of proper antifungal medications. Permanent sequelae were relatively uncommon and related to the structures involved in the primary infection.