On retrospective questioning, the patient recalled a trip to Oklahoma during the past year, which included an overnight stay along the road at a small motel, the location of which he could not remember. He admitted taking an early morning run in a fairly wooded area at this location. Discussion Blastomycosis is a granulomatous fungal infection caused by the organism Blastomyces dermatididis . It is endemic in the midwestern and south central United States but not commonly seen in Florida. It most commonly infects normal healthy people with a predominance in males.
Spores reside in the soil and enter the body by inhalation.
The spores may either be cleared by alveolar macrophages or undergo transition to a yeast phase. The yeast phase is not transmissible from person to person but can disseminate via the bloodstream to other organs in the body. Infection initially produces a suppurative response with polymorphonuclear leukocytes followed by an influx of macrophages forming a distinctive granulomatous reaction. The granulomas typically do not caseate, as is the case in tuberculosis. Patients with blastomycosis can present with symptoms of acute pneumonia, chronic pneumonia or no pulmonary symptoms at all.