Genital blastomycosis and tuberculosis in a patient living with HIV in southeastern Mexico

Abstract

Clinical case description: we present the case of a 17-year-old male from Chiapas, who has a history of HIV infection and neuroinfection caused by Cryptococcus neoformans. He was treated for acute orchiepididymitis, with histopathological identification of Blastomyces spp. and Mycobacterium tuberculosis in the surgical specimen (orchiectomy and epididymectomy).

Relevance: Blastomycosis is infrequent outside endemic regions, and reported cases typically involve patients with a history of travel to or residence in such areas. Genitourinary blastomycosis is rare (accounting for 10 % of total cases) and more commonly affects the prostate, epididymis, and testicles. Tuberculosis of the genitourinary tract is often diagnosed late, leading to irreversible damage and the need for radical interventions such as orchiectomy. Blastomycosis is rare outside of endemic areas; reported cases have a history of travel or residence in these areas. Genitourinary blastomycosis is rare (10 % of all cases) and most frequently involves the prostate, epididymis, and testes. Tuberculosis of the genitourinary tract is often diagnosed late, leading to irreversible damage and the need for radical interventions such as orchiectomy.

Clinical implications: genitourinary blastomycosis is an underdiagnosed infectious condition due to the lack of specific symptoms, with approximately half of patients with blastomycosis remaining asymptomatic.

Conclusions: it is likely that more cases of BM in Mexico are undiagnosed or unreported and are caused mainly by Blastomyces no-dermatitidis species.