American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the most common manifestation of disseminated blastomycosis?

1. Pulmonary complications

2. Skin lesions

3. Abdominal pain

4. Neurological symptoms

The correct answer is: Skin lesions

The most common manifestation of disseminated blastomycosis is skin lesions. Blastomycosis is caused by the fungus Blastomyces dermatitidis, which primarily affects the lungs but can disseminate throughout the body, including to the skin. When dissemination occurs, cutaneous involvement often manifests as a variety of lesions, including ulcerative or verrucous forms, which can be quite distinctive. It's important to note that while pulmonary complications are common in blastomycosis due to the initial inhalation of spores, when the infection disseminates beyond the lungs, skin lesions become the most prevalent outward sign. Dissemination to other organs, such as the abdomen or CNS, is less common compared to the notable skin involvement that typically presents in such cases. This characteristic feature helps to identify and diagnose the condition effectively, emphasizing the importance of recognizing dermatological signs in patients at risk for fungal infections. In summary, the prevalence of skin lesions in disseminated blastomycosis serves as a significant clinical indicator of the disease's progression and is a key factor in identifying and managing this fungal infection.