Bronchoscopic view of pulmonary blastomycosis

Blastomycosis is a chronic fungal infection often diagnosed in the south-central and midwestern United States. Lungs are primarily involved, with lymphatic or hematogenous spread to other organs. Bronchoscopy is considered when the noninvasive tests fail to establish the diagnosis. We describe bronchoscopic finding of blastomycosis involving the upper and lower respiratory tract. Inhaled steroids may have suppressed cellular immunity, allowing fungus to grow in the submucosa with histology significant for extensive eosinophilic infiltration. To our knowledge, such a detailed pictorial description of pulmonary blastomycosis with a cobblestone appearance of the tracheobronchial mucosa has not been reported in the past.