PubMedDate not supplied
BACKGROUND: Blastomycosis is a rare fungal infection that occurs most often in young to middle-aged men. A common route of infection is through continued contact with soil, occurring in such occupations as gardening and construction work. The skin and lungs are primarily affected. When the respiratory system is involved, blastomycosis may be misdiagnosed as pulmonary miliary tuberculosis. CASE: A 54-year-old, African American male presented with dry cough and multiple verrucous skin lesions affecting the face, shoulder and legs. Chest roentgenography indicated bilateral lung involvement. The patient died following a short, difficult hospital course. Autopsy revealed verrucous skin lesions with dry, thick, raised margins and central necrosis and umbilication, and severe, diffuse pulmonary involvement clinically and radiologically, resembling miliary tuberculosis. A smear from a leg ulcer stained by the Papanicolaou technique revealed fungi within the giant cells. CONCLUSION: Clinical and radiologic findings alone do not establish the diagnosis of blastomycosis. Respiratory involvement may lead to a misdiagnosis of pulmonary miliary tuberculosis. Sputum and bronchial washing examinations by a laboratory technique are in order. This case indicates that cytologic examination of the exudate from an ulcer may result in a strongly suggestive diagnosis.