Treatment of primary pulmonary blastomycosis: results of long-term follow-up.

Twenty-three patients with pulmonary blastomycosis were seen from 1950 to 1975, and long-term follow-up, ranging from 2 to 21 years, was available for 19 patients. Four major treatment groups were identified: surgery alone (eight patients), amphotericin B alone (four patients), surgery and amphotericin B (three patients), and observation (four patients). Six of eight patients who had surgical resection alone were cured; one patient died of cardiopulmonary complications in the immediate postoperative period, and one had a relapse 15 years later. The remaining 11 patients in the three other treatment groups were cured. Although systemic therapy with amphotericin B is clearly indicated for progressive, disseminated, or incompletely resected disease, a period of observation is indicated for nonprogressive or totally resected pulmonary blastomycosis.