[Blastomycosis in Morocco: imported mycosis]

Area of Science:

• Mycology
• Infectious Diseases
• Pulmonology

Background:

• Blastomycosis is a rare systemic fungal infection caused by Blastomyces dermatitidis.
• It is endemic in certain regions of North America but infrequently reported globally.
• This case represents the first documented instance in Morocco.

Observation:

• A 41-year-old male presented with a 6-month history of dyspnea, fever, chest pain, night sweats, and weight loss.
• Physical examination revealed a painful paravertebral mass; imaging showed left apical opacity, parenchymal infiltration, and lytic bone lesions.
• Surgical biopsy confirmed granulomatous inflammation with characteristic fungal inclusions.

Findings:

• Fungal studies definitively identified Blastomyces dermatitidis.
• The patient received ketoconazole treatment, resulting in an excellent clinical response.
• Follow-up at 3.5 years indicated a sustained positive outcome.

Implications:

• The non-specific clinical and radiographic presentation of blastomycosis can mimic neoplastic processes, leading to diagnostic delays.
• This case highlights the importance of considering blastomycosis in the differential diagnosis of unexplained pulmonary and bone lesions, even in regions where it is considered rare.
• Successful treatment with ketoconazole underscores its efficacy in managing this fungal infection.