Laryngeal blastomycosis with subsequent heart failure from itraconazole therapy

Blastomycosis is an endemic mycosis in the United States that typically affects the respiratory tract and presents as a pneumonia. Dissemination can occur to any organ system, most commonly involving the skin or bones. Treatment of blastomycosis depends on the severity of disease and consists of itraconazole with liposomal amphotericin B added in during the initial stage in those with more severe disease or those who are pregnant. This case report describes an immunocompetent individual with mild to moderate blastomycosis of the larynx who was started on itraconazole therapy. However, after two months of treatment, he developed new symptomatic heart failure with reduced ejection fraction due to the itraconazole. His therapy was stopped after five months with improvement of his left ventricular ejection fraction days after discontinuation of therapy. He remained without relapse of disease after his abridged therapy duration.