A Budding Pancreatic Mass: A Review of Disseminated Blastomycosis

A 67-year-old male patient presented with anorexia, weight loss, skin masses, and flank pain over the past three months. Imaging revealed a lung mass and a cystic lesion in the pancreatic head. After initial diagnostic work-up and clinical deterioration, broad based budding, seen on pathology, led to a diagnosis of disseminated blastomycosis. After receiving a 14-day course of liposomal amphotericin B followed by itraconazole, the patient showed significant clinical improvement. We reviewed all disseminated blastomycosis cases in the medical literature involving gastrointestinal organs. Although pancreatic involvement is rare, we suggest that it should be suspected in those with a rapidly growing pancreatic mass even in immunocompetent patients. Finally, tissue biopsy should be obtained expeditiously, but repeat biopsy may be indicated if initial results are negative and clinical suspicion remains high.