Blasto in the Bronx: An Unusual Case of Severe Cutaneous Blastomycosis in New York City

Urban cases of blastomycosis are extremely rare and usually involve an individual or individuals with recent travel to, and outdoor exposure in, an endemic area. We report a case of severe cutaneous blastomycosis in a New York City resident. He presented to our hospital in 2023 with multiple cavitary lung nodules and a large area of fungating lesions on his back that had been progressing for a month. Cultures and pathology from the skin lesions confirmed a diagnosis of cutaneous blastomycosis, and the patient was successfully treated with a prolonged course of oral itraconazole. Given no travel history outside of the five boroughs, we believe the patient acquired the infection endemically and is the first published case of blastomycosis acquired in New York City.