Roshan Kothandaram M.D.             St. Mary's Medical Center
Blastomycosis presenting as lobar consolidation in an 
immunocompetent host   
         
 

Blastomycosis is a rare cause of pneumonia in an immunocompetent host. A 33 year old, immunocompetent, Caucasian male developed consolidation of his right upper lobe. Patient failed to respond to multiple courses of antibiotics over a 3 week period. A repeat chest x-ray was unchanged. A CT Scan of the chest confirmed consolidation in the right upper lobe. PPD was negative, as was HIV serology. A CD4 T cell count was increased at 1,962. A CT guided biopsy of the lesion showed budding yeast which was shown on culture to be blastomyces. He was initially treated with Amphotericin B but developed rapid nephrotoxicity prompting a change to oral Itraconazole 400 mg po daily which he tolerated well. Subsequent testing of the isolate demonstrated susceptibility to both Amphotericin B and Itraconazole. He improved steadily and treatment was continued for 1 year. A chest x-ray at that time showed only RUL residual fibrosis. Fungal pneumonias may mimic bacterial pneumonias. Lobar consolidation unresponsive to antibacterial therapy should lead to an aggressive diagnostic approach.