Pulmonary blastomycosis

Last revised by Arlene Campos on 12 Jan 2024

Pulmonary blastomycosis refers to respiratory infection with the organism Blastomyces dermatitidis. It is a pyogranulomatous fungal infection and the respiratory system is the commonest site of infection with this organism. The disease is endemic to North America.

Clinical presentation

There can be marked variation in presentation ranging from from asymptomatic infection to rapidly severe and fatal disease. Most will present as an acute to chronic pneumonia or may be discovered as a mass-like lung opacity on a radiograph 1.

Radiographic features

Plain radiograph

While individual features are non-specific, several radiographic patterns have been described which include air-space disease, nodular opacities, mass-like lesions, interstitial disease, cavitation (37% 8) and miliary disease 6,7. The air space consolidation and mass-like opacities may have an upper lobe predilection 9.

Lymphadenopathy and pleural effusions may be uncommonly present.

Traversal of lung fissures has also been seen.

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