North American blastomycosis in children and adolescents is not commonly encountered. It is caused by the dimorphic fungus, Blastomyces dermatitidis, and was originally described by Gilchrist in 1894¹ and 1896.² The typical patient is a male between the ages of 30 to 50 years who has had significant exposure to the outdoors.³ The rare occurrence in children and adolescents and the varied spectrum of clinical involvement make infection with B dermatitidis a potential diagnostic challenge in this patient population. A recent retrospective review at a large children's hospital during the period 1983-1995 identified only 10 patients with the disease.⁴ It was also noted that the diagnosis of pulmonary blastomycosis is more difficult in children, with 4 of 5 patients requiring open-lung biopsy for diagnostic confirmation. We present a case of disseminated North American blastomycosis in an adolescent male whose diagnosis was delayed for 4 months from the onset of symptoms.

	CASE REPORT

A previously healthy 15-year-old African-American male presented on dermatologic consultation with chronic respiratory symptoms, left wrist pain, and verrucous skin lesions. His symptoms had begun 4 months before with fever to 40°C, cough, and rhinorrhea. Initial treatment consisted of a 10-day course of amoxicillin for a presumed upper respiratory infection, without improvement. A chest radiograph revealed a right middle lobe infiltrate, but despite a 10-day course of erythromycin, his cough persisted and he developed wheezing. In addition, he noted the onset of left wrist pain and subsequently developed a tender, erythematous, verrucous plaque over the area. On incision and drainage of this lesion, large amounts of purulent material were noted. He was again prescribed a course of oral . . . [Full Text of this Article]