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Clinical Presentation

Patient is a 36 year-old African American male from Baton Rouge, La. He was admitted into the ER suffering from shortness of breath and productive cough for two weeks. Ulcerative lesions are found on the patient’s left calf. Patient reports pain located at the knees. HIV test was positive. Chest x-rays and tissue biopsy were performed. The tissue biopsy of the ulcerative lesions showed fungal organism that suggest Blastomyces dermatidis. In addition, a sputum test was performed and found fungal organism present confirming Blastomyces dermatidis.

Patient began working on a construction site along the river about two months ago. Reports of patients suffering similar symptoms have been found in the past year in the same area that this patient worked at. Officials are testing the soil to determine if conidia of Blastomyces dermatidis are present. Patient was put on itraconazole for two weeks. Initial progress was slow but the fungal infection eventually cleared up. Lesions are beginning to heal and patient reports that he no longer have trouble breathing. His coughs are reduced as well. Long-term treatment with itraconazole is required in order to prevent a reoccurrence.