Symptoms and Signs Acute, self-limited blastomycosis is seldom recognized clinically. Pulmonary blastomycosis tends to occur as individual cases of progressive infection requiring therapy. Focal or diffuse infiltrates may be present, sometimes as a patchy bronchopneumonia fanning out from the hilum, resembling a neoplasm. Most often, the infection has an insidious onset and is chronic. Symptoms are nonspecific and may include a productive or dry hacking cough, chest pain, dyspnea, fever, chills, and drenching sweats.
Pleural effusion occurs occasionally.
Some patients have rapidly progressive infections, and adult respiratory distress syndrome may develop. In extrapulmonary disseminated blastomycosis, hematogenous spread may lead to focal infection in skin, prostate, epididymis, testis, kidneys, vertebrae, ends of long bones, subcutaneous tissues, brain, oral or nasal mucosa, thyroid, lymph nodes, bone marrow, and other tissues. Sometimes areas overlying bone lesions are swollen, warm, and tender. Some genital lesions present as painful epididymal swelling, deep perineal discomfort, or prostatic tenderness on rectal examination. Skin lesions are by far the most common, may be single or multiple, and may occur with or without clinically apparent pulmonary involvement.