Pleural effusion from blastomycetes in an adult Nigerian: a case report

A 37 year old hide and skin trader in Northern Nigeria, presented with massive right sided purulent pleural effusion. This started with cough, chest pain and fever for 5 weeks following endotracheal intubation. He had chest tube inserted and was treated with antituberculous drugs for 10 weeks without improvement. Fungal studies on the sputum, and pleural fluid yielded Blastomycetes dermatitidis which responded excellently to ketoconazole and saline pleural lavage. This experience underscores the need for early suspicion of systemic mycosis in suspected cases of tuberculosis with poor or no response to treatment. This will reduce morbidity, mortality and cost of treatment.