Overwhelming Pulmonary Blastomycosis Associated with the Adult Respiratory Distress Syndrome

Blastomycosis is a relatively common pulmonary and cutaneous mycosis encountered in people living in the Mississippi River basin, around the Great Lakes, and in the southeastern United States 1 , 2 . It is estimated that as many as four cases of symptomatic Blastomyces dermatitidis infection requiring treatment with antifungal drugs occur per 100,000 population each year in the United States in areas in which the disease is endemic 3 . It is likely that many more patients have asymptomatic or transiently symptomatic infection that is self-limiting and never recognized as blastomycosis 1 , 4 . Pulmonary blastomycosis characteristically causes an acute or chronic pneumonitis, . . .