Blastomyces dermatitidis and the adult respiratory distress syndrome. Case reports and review of the literature.

The adult respiratory distress syndrome (ARDS) developed in 2 patients with blastomycosis. In one, ARDS apparently followed the rupture of an infected subcarinal lymph node into a bronchus. Extensive involvement of alveoli with Blastomyces dermatitidis was noted at autopsy in both patients. Four additional cases of blastomycosis with definite or presumed ARDS are reviewed. The clinical course of these 6 patients was characterized by a prolonged prodrome (median, 36 days), consistent with pulmonary blastomycosis, and a rapid demise (median, 5 days) associated with ARDS.