Blastomycosis presenting as recurrent tender cutaneous nodules.

Blastomycosis is caused by inhalation of airborne spores from Blastomyces dermatitidis, a dimorphic fungus found in soil. It is endemic in the southeastern, Midwestern, and south central states of North America. The clinical spectrum of blastomycosis is varied, including asymptomatic infection, acute or chronic pneumonia, and disseminated disease. Definitive diagnosis is based on identification of the characteristic thick-walled, broad-based budding yeasts by direct examination of tissue or the isolation of Blastomyces in culture. Itraconazole is the treatment of choice for mild to moderate pulmonary disease. Amphotericin B is the first line agent in life-threatening disseminated disease, central nervous system involvement, acute respiratory distress syndrome, pregnancy, immunocompromised states, and in those who cannot tolerate or fail azole therapy. We report a case of blastomycosis presenting as a fever of unknown etiology and recurrent skin nodules.