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. The typical patient is a male between the ages of 30 to 50 years who has had significant exposure to the outdoors. 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. 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...

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