A 36-year-old woman with gallbladder disease had an incidental finding
of asymptomatic cavitary lung infection with Blastomyces dermatitidis
. No treatment was given initially, and 2 months later she presented w
ith vertebral osteomyelitis, paraspinal abscess, and spinal cord compr
ession due to dissemination of the fungus. The patient recovered follo
wing surgical debridement and treatment with 1 g of amphotericin B, fo
llowed by itraconazole 400 mg QD for 6 months. In spite of previous re
ports of the self limiting nature of primary pulmonary blastomycosis i
n the normal host, antifungal therapy may be needed in cases that do n
ot resolve spontaneously within a short period of time, or if transien
t immunosuppression may be anticipated as may occur following surgery
or after acquisition of other infections.