Acquired immunodeficiency syndrome-related blastomycosis in an unusual geographic location

Blastomycosis is a fungal infection acquired via inhalation of Blastomyces dermatitidis. The majority of cases occur in central, southeastern, and mid-Atlantic areas of the United States. We report the case of a 42-year-old veteran infected with the human immunodeficiency virus who presented in E1 Paso, Texas, with a dry cough, fever, and recent weight loss. We review the clinical and epidemiologic features of blastomycosis. Diagnostic criteria and pharmacologic management are discussed. Active duty personnel are at high risk of exposure to B. dermatitidis. Military providers should maintain an index of suspicion for blastomycosis in endemic and nonendemic regions.