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Synopsis The etiologic agents of blastomycosis, Blastomyces dermatitidis and B. gilchristii, belong to a group of thermally dimorphic fungi that can infect healthy and immunocompromised individuals. Following inhalation of mycelial fragments and spores into the lungs, Blastomyces spp. convert into pathogenic yeast, which facilitates evasion of host immune defenses to cause pneumonia and disseminated disease. The clinical spectrum of pulmonary blastomycosis is diverse, ranging from subclinical infection, acute pneumonia resembling bacterial community-acquired pneumonia, chronic pneumonia mimicking tuberculosis or malignancy, and acute respiratory distress syndrome. The diagnosis of blastomycosis requires a high-degree of clinical suspicion and involves the use of culture and non-culture-based fungal diagnostic tests. The site and severity of infection, and the presence of underlying immunosuppression or pregnancy influence selection of antifungal therapy.

Blastomycosis is an uncommon infection following solid organ transplantation that is frequently complicated by ARDS, dissemination, and opportunistic co-infection. After cure, post-transplant blastomycosis may not require lifelong antifungal suppression.

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