OBJECTIVE Pleural effusion secondary to blastomycosis infection is an uncommon clinical manifestation of the disease. We undertook a retrospective study to assess the incidence and involvement of pleural effusion in patients with blastomycosis infection. STUDY DESIGN Institutional cytology and surgical pathology records were searched from December 1995 to October 2017 for cases of blastomycosis. The cytologic, surgical pathology, and clinical pertinent information was reviewed in detail. RESULTS A total of 77 cases of blastomycosis infection were recorded, with a male-to-female ratio of 1.7:1.0. Forty-eight cases of blastomycosis were pulmonary (62.3%), while 29 cases of blastomycosis were found in extrapulmonary sites (37.7%). The diagnosis of pulmonary blastomycosis was established by 24 lung biopsies/wedge resections, 22 bronchial alveolar lavages, and 2 lung fine needle aspirations. The 29 cases of extrapulmonary blastomycosis included 13 cases of bone (44.8%), 8 cases of skin (27.6%), 6 cases of soft tissue (20.7%), and 2 cases of brain infections (6.8%). Twenty-eight of 48 pulmonary cases were complicated by unilateral or bilateral pleural effusion (58.3%) detected by imaging studies. Four of the 28 pleural effusions were aspirated and examined by cytology. Two of the 4 pleural fluid cytologies showed involvement by blastomycosis (50%). In the extrapulmonary blastomycosis group, 9 of 29 patients showed unilateral or bilateral pleural effusions (31.0%), including 4 cases of bone, 4 cases of skin, and 1 case of brain involvement. Only 2 of the 9 pleural effusions were aspirated for cytology study. One of the 2 pleural fluid cytologies showed blastomycosis (50%). CONCLUSION Pleural effusion detected by imaging is common in blastomycosis patients. Blastomycosis can involve pleural fluid in both pulmonary and extrapulmonary diseases. A broad infectious differential that includes blastomycosis should be considered to make a timely diagnosis and initiate antifungal therapy to prevent systemic infection and further dissemination of the disease.

中文翻译：

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肺和肺外芽孢杆菌病的胸腔积液。

目的继发于芽孢杆菌病感染的胸腔积液是该病的罕见临床表现。我们进行了一项回顾性研究，以评估母细胞增多症感染患者胸腔积液的发生率和受累情况。研究设计自1995年12月至2017年10月在机构细胞学和外科病理学记录中搜索了芽孢杆菌病病例。细胞学，外科病理学和临床相关信息进行了详细的审查。结果共记录了77例芽孢杆菌病感染，男女之比为1.7：1.0。肺芽孢杆菌病48例（62.3％），在肺外部位发现29例胚芽菌病（37.7％）。通过24例肺活检/楔形切除术可以诊断肺母细胞菌病，22支气管肺泡灌洗，2肺细针穿刺。29例肺外芽孢杆菌病包括骨13例（44.8％），皮肤8例（27.6％），软组织6例（20.7％）和脑部感染2例（6.8％）。影像学检查发现48例肺部疾病中有28例并发单侧或双侧胸腔积液（58.3％）。抽出28例胸腔积液中的4例，并通过细胞学检查。4种胸腔积液细胞学中有2种显示出了芽孢杆菌病的侵袭（50％）。在肺外芽胞菌病组中，29例患者中有9例表现出单侧或双侧胸腔积液（31.0％），包括骨4例，皮肤4例和脑受累1例。9例胸腔积液中只有2例被抽出用于细胞学研究。2种胸水细胞学之一显示为胚芽菌病（50％）。结论影像学检测到的胸腔积液在沙门氏菌病患者中很常见。沙门氏菌病可累及肺和肺外疾病中的胸膜液。应该考虑广泛的感染差异，包括芽孢杆菌病，以便及时诊断并开始抗真菌治疗，以防止全身感染和进一步传播疾病。