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Blastomycosis with rapid-onset acute respiratory distress syndrome in an urban setting
  1. Arnav Agarwal1,
  2. Jennifer A Losie2,
  3. Dylan Kain3 and
  4. Rupert Kaul3
  1. 1Department of Medicine, University of Toronto, Toronto, Canada
  2. 2Division of Infectious Diseases, Department of Medicine, The University of British Columbia, Vancouver, Canada
  3. 3Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
  1. Correspondence to Dr Rupert Kaul; rupert.kaul{at}


While blastomycosis is endemic to eastern USA and northwestern Ontario, acquisition is an anomaly in urban settings. We present a 54-year-old immunocompetent man from the greater Toronto area with no travel, who presented with a 3-week history of chest pain and dyspnoea. Initial radiographic workup revealed a mass-like opacification in the right apical mediastinum. Extensive investigations including bronchoscopy with bronchoalveolar lavage, mediastinal mass biopsy with fungal and mycobacterial cultures and multiple stains, and CT were unrevealing. The patient progressed to respiratory failure over 4 months. Ultimately, sputum and bone marrow cultures confirmed a diagnosis of disseminated blastomycosis. The patient required prolonged extracorporeal membrane oxygenation and ongoing ventilation postdecannulation. Our case highlights diagnostic challenges with blastomycosis, particularly in immunocompetent individuals with no travel to recreational areas, and emphasises the importance of maintaining a high index of suspicion and sending fungal cultures of appropriate specimens and/or cytopathology in clinically compatible cases.

  • infectious diseases
  • general practice / family medicine
  • pneumonia (infectious disease)
  • mechanical ventilation
  • adult intensive care

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  • Contributors AA, JAL and DK equally contributed to data collection and preparation of the initial draft of the manuscript. All authors made critical revisions to the manuscript draft and approved the final version. DK and AA obtained patient consent with family assistance.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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