Acquired Blastomycosis infection in a patient with prior Roux-en-Y bariatric surgery: A case report

Blastomycosis is a fungal infection endemic to parts of North America, often presenting with subtle respiratory symptoms but capable of affecting multiple organ systems. We describe a 41-year-old woman with a history of Roux-en-Y gastric bypass who presented with non-specific gastrointestinal complaints and severe nutritional deficiencies. Imaging revealed cavitary lesions in the lungs, and bronchoscopy confirmed Blastomyces sp. infection. She improved with prolonged itraconazole therapy. In patients with severe malnutrition leading to immunosuppression, especially in endemic areas, clinicians should consider blastomycosis in the differential diagnosis when subtle respiratory symptoms are presents to facilitate timely diagnosis and treatment.