Systemic Blastomycosis

¹ The Muirdale Sanatorium, Wauwatosa, Wisconsin, and Marquette University School of Medicine., Medical Director, J.C.R.S. Sanatorium, Spivak, Colorado.
² The Muirdale Sanatorium, Wauwatosa, Wisconsin, and Marquette University School of Medicine.

1) Eleven cases of systemic blastomycosis are reported. Seven are dead; four are living eight, seven, four and one-half, and three years, respectively, after the diagnosis was established.

2) Pulmonary symptoms were predominant, and except when tuberculosis coexisted with the blastomycosis, pulmonary tuberculosis was the initial diagnosis.

3) The roentgenologic appearance may simulate practically any type of pulmonary pathology. It has no particular pattern. Five of our cases showed upper lobe consolidation.

4) In two of our cases large pulmonary cavities were present; this is contrary to the usual reports.

5) Cutaneous manifestations usually are present, and should be searched for because small innocent-looking abscesses may yield the organism.

6) Sputum examination usually will reveal the blastomyces either on wet smear or culture. Animal inoculation may be necessary. In our experience it was disappointing.

7) Biopsy material should be examined carefully and the diagnosis made only when the organism is found.

8) Iodide was the drug of choice in this series.

9) One case in which pulmonary resection was performed ended fatally.