A Case Report of a 74-Year-Old Immunocompromised Host Diagnosed with Pulmonary Blastomycosis and Pulmonary Hemorrhage

Patient: Male, 74-year-old Final Diagnosis: Blastomycosis Symptoms: Cough • hemoptysis • shortness of breath Medication: — Clinical Procedure: Bronchoscopy Specialty: Critical Care Medicine OBJECTIVE: Rare disease BACKGROUND: Blastomycosis is a rare opportunistic disease caused by inhalation of the fungus Blastomyces dermatitidis. Blastomycosis can occur in all individuals but is most commonly seen in immunocompromised hosts. If left untreated or not caught early enough, blastomycosis can progress to fulminant multilobar pneumonia, acute respiratory distress syndrome (ARDS), and even death. CASE REPORT: A 74-year-old immunocompromised man in northeast Ohio presented to the Emergency Department with shortness of breath and hemoptysis. The patient had a negative evaluation for a gastrointestinal bleed and was found to have significant blood collection in the larynx and trachea. A bronchoscopy demonstrated right upper lobe hemorrhage and an infection with Blastomyces species. The patient was started on amphotericin B 5 mg/kg every 24 h for severe blastomycosis. The patient continued to have pulmonary hemorrhage and progressed to multilobar pneumonia and ARDS. Ultimately, the patient died due to respiratory distress after being hospitalized for 5 days. CONCLUSIONS: Blastomycosis can present with multiple clinical manifestations, including pulmonary hemorrhage, in severe disease. Diagnostic delay of blastomycosis is common owing to a nonspecific patient presentation. Blastomycosis is an opportunistic infection; therefore, the fungus can be more commonly seen within immunocompromised hosts. The combination of diagnostic delay and immunocompromised hosts leads to an increased mortality rate from blastomycosis infections.