A Rare Case of Recurrent Blastomycosis in North America

Blastomycosis is a chronic granulomatous and suppurative mycoses caused by Blastomyces dermatitidis. The majority of cases show a primary pulmonary disease. We report a 65-year-old male patient with two painless, violaceous nodules over the left chest wall and right inner thigh. Initially, differential diagnoses of disseminated Blastomycosis, Pneumonia, and Diffuse large B-cell lymphoma made based on past and present clinical history and presentation. The final diag-nosis of disseminated with secondary cutaneous Blastomycosis in a followup case of Diffuse large B-cell lymphoma made based on skin biopsy, broncho-alveolar lavage, and bronchial brushing showing budding yeasts of Blastomyces. The patient responded well to therapy with Amphotericin B and Itraconazole along with intravenous methylprednisolone.