Direct Tissue PCR and Genotyping for Species Identification in a Case of Laryngeal Blastomycosis

Otolaryngologic manifestations of infection with Blastomycesspecies are extremely rare and restricted geographically to recognized endemic regions. Here, we describe a case of laryngeal blastomycosis that presented as slowly progressive dysphonia. While a preliminary diagnosis was made using routine histopathology, a species identification of Blastomyces dermatitidiswas made using polymerase chain reaction amplification and rapid genotyping without the need for fungal culture. All symptoms resolved following 1 month of antifungal therapy. Rapid molecular differentiation of B dermatitidisfrom Blastomyces gilchristiiprovides important insights into pathogenesis given recent recognition of differences in clinical spectra.