Blastomycosis

(CID 2008;46:1801)

• Epidemiology endemic to the eastern ½ of U.S.
• Clinical manifestations
  • Acute:
    • PNA w/o hilar LAN that can progress to ARDS
  • Chronic:
    • cough + “B” sx, fibronodular infiltrates, masses ± cavitary lesions (Ddx TB, histo)
  • Disseminated (seen in immunosupp.):
    • rash (verrucous, ulcerated lesions),
    • subcutaneous nodules, osteo, GU (prostatitis, epididymoorchitis), CNS involvement uncommon
• Treatment:
  • mild to mod: itraconazole;
  • disseminated/severe/CNS: ampho → itraconazole