Abstract
Blastomycosis is a rare fungal infection endemic to North America and parts of Africa. It can be challenging to diagnose until it reaches a critical stage. We present a blastomycosis case in Alabama, emphasizing the importance of early recognition and management. A 67-year-old man had a month of worsening respiratory symptoms, which included malaise, cough, shortness of breath, and fever. Despite multiple urgent care visits and treatments with antibiotics and steroids, his condition continued to deteriorate. He was hospitalized with persistent fever and hypoxia. The imaging revealed patchy lung disease and multifocal consolidations, but initial cultures revealed no growth. He ultimately underwent bronchoscopy for budding yeast consistent with blastomycosis, along with influenza A. Treatment with amphotericin B was started, and there was a significant improvement. This case illustrates the need to consider the diagnosis of blastomycosis in a patient presenting with persistent respiratory symptoms unresponsive to conventional treatments.