Missouri Man Left Covered in Strange Growths After Being Scraped by Trees

A landscaper was left with raised itchy skin lesions after being exposed to a fungus that grows in wood, leaves, and soil.

The case, reported by doctors in Missouri, involved a 53-year-old man who arrived at a dermatology clinic complaining of red, itchy marks on his left lower back and buttock that had not gone away for four months.

The man had no known medical history, though through his work as a landscaper he often sustained some skin injuries whilst trimming trees.

On examination, doctors realized that the man's affected area was covered with wart-like marks and decided to investigate further to identify what was causing them. Using a method known as Grocott-Gomori's Methenamine Silver Staining, doctors found "budding fungal organisms" according to a case report.

They suspected that the fungal infection was caused by Blastomyces dermatitidis, which was confirmed by a urine test.

The doctors did not explicitly state that the man's infection was caused by being scraped by trees.

Blastomycosis is a rare fungal infection that is usually caused by breathing in the spores of the fungi Blastomyces dermatitidis or Blastomyces gilchristii. It is also possible for the fungus to directly infect the skin—as was the case with the landscaper—such as through an open skin wound, though this happens "very rarely" according to the Minnesota Department of Health.

These fungi can be found in moist soils as well as in decomposing matter like wood and leaves, according to the U.S. Centers for Disease Control and Prevention. In the U.S., it mainly lives in midwestern, south-central, and southeastern states.

Spores are more likely to be airborne if contaminated material is disturbed, such as by digging or wood clearing.

There's no vaccine to prevent infection and it may not be possible to prevent exposure in an area where the fungus is common. The CDC states: "People who have weakened immune systems may want to consider avoiding activities that involve disrupting soil in these areas."

Symptoms appear in around half of people who are infected with Blastomyces and can include fever, cough, night sweats, muscle or joint pain, weight loss, chest pain, fatigue, and skin sores. Severe infections are possible, particularly in people with weakened immune systems.

Most people with blastomycosis will need treatment with antifungal medication over a period ranging from six months to a year depending on the severity of the infection and the person's immune status.

In the case of the 53-year-old landscaper, the skin lesions cleared up within six months after he was prescribed medication.

Dr. Albert Alhatem, a dermatopathologist at Saint Louis University in Missouri who co-authored the report, told Newsweek: "This case was very interesting in a sense that this fungal infection rarely affects the skin only. It usually presents as a systemic disease targeting the lung specifically along with other organs.

"Blastomyces dermatitidis typically grows in soil and wood. Therefore, working unprotected in landscaping (trimming trees) or other types of work that an individual might sustain injuries from wood or soil could be a risk factor. According to the literature, the case fatality rate for disseminated blastomycosis was 78% prior to the availability of specific fungal therapy.

"The problem with these types of infections are not immediately recognized and treated, which could lead to multiorgan involvement. The other important point is related to geography as this type of fungus is more common in the eastern half of the U.S.

"Our patient visited the dermatologist and we diagnosed him quickly. The fact that his lungs and other organs were disease free helped our chances of treating him successfully. The treatment was with systemic antifungal therapy with full recovery after six months.

"The general public, especially people who work in landscaping, should be aware of this fungal infection, wear protective clothing or equipment, and visit their doctors early if they notice skin lesions."

The case was reported in The New England Journal of Medicine on May 5, 2022.