Extracorporeal membrane oxygenation for overwhelming Blastomyces dermatitidis pneumonia

Blastomyces dermatitidis is a fungus that is found primarily in endemic are as of the midwestern and southcentral USA. Blastomycosis pneumonia may deve lop after the inhalation of spores. While blastomycosis may lead to acute o r chronic pneumonitis, it will rarely result in the development of the acut e respiratory distress syndrome (ARDS). In this situation, mortality rates are 50-80%. Patients who survive, however, commonly show good recovery of p ulmonary function. Extracorporeal membrane oxygenation (ECMO), a modified f orm of cardiopulmonary bypass that allows systemic perfusion, oxygenation, and carbon dioxide removal, may be used to support patients with cardioresp iratory failure that is refractory to conventional therapies. The use of EC MO allows the reduction of high levels of mechanical ventilatory support th at may cause iatrogenic injury to the diseased lung. Fungal diseases are of ten contraindications for ECMO use, since systemic fungal organisms may bin d to the ECMO circuit and be difficult to eradicate. It may be reasonable t o utilize ECMO, however, if the fungal infection is isolated to the respira tory system. We report the case of a patient with ARDS secondary to blastom ycosis pneumonia who was treated with ECMO due to the failure of convention al cardiorespiratory supports. To our knowledge, this is the first report o f the use of ECMO for this condition.