CTICasesBlastomycosis Mimicking Community-Acquired Pneumonia
Imaging findings
A 49-year-old presented with cough and fever and left lower lobe consolidation resembling community-acquired pneumonia, which failed to respond to treatment. CT, degraded by poor breath-holding, shows consolidation filling most of the lower lobe with a small amount of dry cavitation and no fluid level, surrounding almost lobular ground glass, and a little septal thickening that may represent localized edema or part of the process itself. There is zero to minimal pleural reaction and only mild mediastinal lymphadenopathy.
Key takeaways
Consolidative pneumonia that does not respond to standard therapy in an immunocompetent outpatient should prompt consideration of non-bacterial causes. Bacterial pneumonia usually produces more pleural effusion and more lymph node enlargement than was present here. Bronchoalveolar lavage established blastomycosis. Cases cluster in late spring, when decaying vegetation is disturbed during yard and farm cleanup in warm, wet conditions, although infection is seen year-round.
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