Disseminated blastomycosis in a 36-year-old immunocompetent male from Chicago, IL

Blastomycosis is a fungal infection caused by Blastomyces species. This infection is endemic to North America particularly states bordering the Mississippi, Ohio and St Lawrence Rivers, and the Great Lakes but also occurs worldwide. While the most common site of infection is the lung, it can also manifest in the bones, skin and central nervous system. Blastomycosis is a great masquerader and it can present in a manner difficult to distinguish from bacterial pneumonia, tuberculosis (TB), histoplasmosis or carcinoma. Here, we describe a 36-year-old male with disseminated blactomycosis infection who presented with right arm weakness. Initial diagnostic evaluation was cofounded by a previous concern for TB; however, broncho-alveolar lavage confirmed Blastomyces spp. Pulmonary and brain lesions markedly improved after Amphotericin and Itraconazole.