Blastomycosis of the esophagus presenting with gastrointestinal bleeding

A patient with abdominal discomfort and hematemesis was found to have lower esophageal inflammation on endoscopy. A biopsy specimen from this area showed yeast forms of Blastomyces dermatitidis with a polymorphonuclear infiltrate and granuloma formation. Extensive evaluation showed no other bleeding site. Sputum samples obtained earlier also showed B. dermatitidis. Treatment with amphotericin B led to resolution of bleeding and eradication of the fungus on repeat biopsy and sputum samples. An esophageal stricture subsequently developed and required dilation. Seven previously reported cases of esophageal blastomycosis are reviewed.