{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:10:02Z","timestamp":1756275002238,"version":"3.44.0"},"reference-count":8,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,1,27]]},"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:p>While blastomycosis is endemic to eastern USA and northwestern Ontario, acquisition is an anomaly in urban settings. We present a 54-year-old immunocompetent man from the greater Toronto area with no travel, who presented with a 3-week history of chest pain and dyspnoea. Initial radiographic workup revealed a mass-like opacification in the right apical mediastinum. Extensive investigations including bronchoscopy with bronchoalveolar lavage, mediastinal mass biopsy with fungal and mycobacterial cultures and multiple stains, and CT were unrevealing. The patient progressed to respiratory failure over 4\u2009months. Ultimately, sputum and bone marrow cultures confirmed a diagnosis of disseminated blastomycosis. The patient required prolonged extracorporeal membrane oxygenation and ongoing ventilation postdecannulation. Our case highlights diagnostic challenges with blastomycosis, particularly in immunocompetent individuals with no travel to recreational areas, and emphasises the importance of maintaining a high index of suspicion and sending fungal cultures of appropriate specimens and\/or cytopathology in clinically compatible cases.<\/jats:p>","DOI":"10.1136\/bcr-2020-239498","type":"journal-article","created":{"date-parts":[[2021,2,22]],"date-time":"2021-02-22T11:36:46Z","timestamp":1613993806000},"page":"e239498","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Blastomycosis with rapid-onset acute respiratory distress syndrome in an urban setting"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0931-7851","authenticated-orcid":false,"given":"Arnav","family":"Agarwal","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer A","family":"Losie","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, The University of British Columbia, Vancouver, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dylan","family":"Kain","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rupert","family":"Kaul","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,2,22]]},"reference":[{"key":"2025082622385196000_14.2.e239498.1","unstructured":"Sources of Blastomycosis . [Internet] Centers for Disease Control and Prevention, 13 Aug, 2018. Available: www.cdc.gov\/fungal\/diseases\/blastomycosis\/causes.html [Accessed 10 Nov 2019]."},{"key":"2025082622385196000_14.2.e239498.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccm.2017.04.006"},{"key":"2025082622385196000_14.2.e239498.3","doi-asserted-by":"crossref","first-page":"200","DOI":"10.14745\/ccdr.v43i10a02","article-title":"Blastomycosis hospitalizations in northwestern Ontario: 2006-2015","volume":"43","author":"Litvinjenko","year":"2017","journal-title":"Can Commun Dis Rep"},{"key":"2025082622385196000_14.2.e239498.4","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1155\/2015\/468453","article-title":"Blastomycosis in northwestern Ontario, 2004 to 2014","volume":"26","author":"Dalcin","year":"2015","journal-title":"Can J Infect Dis Med Microbiol"},{"key":"2025082622385196000_14.2.e239498.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2015.10.002"},{"key":"2025082622385196000_14.2.e239498.6","doi-asserted-by":"publisher","DOI":"10.1086\/340049"},{"key":"2025082622385196000_14.2.e239498.7","doi-asserted-by":"publisher","DOI":"10.1007\/s11046-008-9163-7"},{"key":"2025082622385196000_14.2.e239498.8","doi-asserted-by":"publisher","DOI":"10.1378\/chest.121.3.768"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-239498","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T05:38:58Z","timestamp":1756273138000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-239498"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2]]},"references-count":8,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2,22]]},"published-print":{"date-parts":[[2021,2]]}},"alternative-id":["10.1136\/bcr-2020-239498"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-239498","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,2]]}}}