NECK MASS RESULTING FROM LOCAL EXTENSION OF PULMONARY BLASTOMYCOSIS

Blastomycosis is an endemic systemic fungal infection that usually inv olves the lungs and superficial skin. Although head and neck involveme nt has been reported in the literature, no previous cases of neck mass resulting from direct extension of a pulmonary lesion have been publi shed, We encountered an immunocompetent 31-year-old woman with a rapid ly enlarging subcutaneous neck mass and a chronic upper lung infiltrat e. Imaging studies showed contiguity between both lesions, Blastomyces dermatitidis was recovered from the sputum, and typical yeast was obs erved in fungal stains of needle aspirate from the neck mass. The pati ent responded favorably to a 6-month course of itraconazole, Blastomyc osis should be considered in patients with subcutaneous neck masses in areas where this disease is endemic.