Blastomycosis-induced respiratory failure: the successful application of continuous positive airway pressure.

A patient diagnosed with pulmonary blastomycosis was seen initially by her primary care physician for severe pain in her right elbow and was treated with steroid therapy and analgesics. She also had been treated for chronic cough and congestion for approximately 2 months before admission. She showed no improvement at home. She was hospitalized for right epicondylitis, and progressively worsening restrictive pulmonary symptoms developed, including hypoxemia and dyspnea. She was transferred to the intensive care unit and treated with mask continuous positive airway pressure (CPAP) and intravenous amphotericin B. Despite worsening hypoxemia, successful management of oxygenation was achieved with CPAP, averting the need for intubation and mechanical ventilation. This case demonstrates the usefulness of CPAP in infectious disorders that create restrictive lung impairment.