LAUSR

Blastomycosis is a fungal infection endemic to the Great Lakes region and Mississippi River Valley,1 although it is found worldwide. Although asymptomatic infections have been recognized, blastomycosis is usually a respiratory syndrome with rare cases of fulminant respiratory failure from acute respiratory distress syndrome. Dissemination to skin, bone, and other organs without obvious lung disease is not uncommon.2 Six distinct species of Blastomyces have been described,3, 4 with 4 that are pathogenic to humans. Of these, Blastomyces dermatitidis is more likely to cause disseminated disease and Blastomyces gilchristii is more often associated with pulmonary-only disease.2 Blastomyces percursus and Blastomyces helicus are newly described human pathogens, and not much is known about how they present clinically. Gestational blastomycosis is rare and presents a risk for disseminated disease in the mother and fetus because of the relative immunosuppression of pregnancy.5, 6, 7 Systemic blastomycosis in pregnant patients may be fatal to the fetus, especially when left untreated.5 We describe an adolescent patient with untreated cutaneous blastomycosis that remained in situ through 2 pregnancies.