BLASTOMYCOSES DERMATITIDIS IN KANSAS. Linh T. Nguyen, MD, and Maha Assi, MD, MPH. KU School of Medicine-Wichita. Blastomycoses dermatitidis is a dimorphic fungus that is capable of causing disseminated infection even in immunocompetent hosts. It exists in nature as a mold and converts to a yeast at a temperature of 37°C. Blastomycoses dermatitidis is typically contracted by inhalation of the conida in the environment. Infection primarily involves the lung, but may also disseminate to other organs, most commonly skin and bone. Although not endemic in Kansas, Blastomycoses dermatitidis is known to be endemic in the central United States, specifically around the Ohio and Mississippi river valleys. Several cases have also occurred in parts of Canada. A 10-year retrospective chart review performed at Infectious Disease Consultants office in Wichita revealed six cases of Blastomycoses dermatitidis identified in Kansas. The patients demonstrated a variation in clinical presentation and a delay in diagnosis. Pulmonary involvement was seen in five of the six cases and was mistaken for either pneumonia or malignancy on presentation. Two patients were asymptomatic and found incidentally to have nodules on chest radiograph. Of the three patients with cutaneous involvement, only one had primary cutaneous blastomycosis. Two patients had dissemination to bone. Exposure to soil was unknown in five of the cases. Only one patient was immunocompromised, demonstrating that this is not an opportunistic infection. Blastomycoses dermatitidis was identified by direct visualization from a culture in three cases and was diagnosed via polymerase chain reaction in the remaining three cases. Five patients responded to treatment with anti-fungals. Only one patient was started on liposomal amphotericin B, then switched to itraconazole. Two patients received itraconazole and one received fluconazole. Another patient received itraconazole initially, but was later switched to fluconazole for long term treatment. One patient did not receive anti-fungal therapy due to complete resection of the lung nodule. Follow-up duration ranged from one month to fifteen months with no evidence of relapse. The cases reviewed demonstrate the complexity associated with Blastomycoses dermatitidis infection and the difficulty in timely diagnosis. Although not endemic to Kansas, Blastomycoses dermatitidis should be included in the differential diagnosis of patients presenting with a syndrome of pulmonary, integumentary, and or bone involvement in both immunocompetent and immunocompromised individuals. .