Unexpected Blastomyces dermatitidis Etiology of Fungal Sinusitis and Erosive Palatal Infection in a Diabetic Patient

We present what is believed to be the initial report of hard-palate infection caused by Blastomyces dermatitidis. The organism was cultivated from biopsy material obtained from a diabetic patient presenting with complaints of headache and malaise. Ra-diologic findings revealed a malignant-appearing soft-tissue mass with paranasal sinus base destruction. CASE REPORT A79-year-old female presented for evaluation of a 4- to 5-dayhistory of malaise and bilateral frontal lobe headache. Asso-ciated pain was characterized as moderate to severe. The patient was withdrawn and uncooperative during the examination. Weakness, dizziness, loss of appetite, and dysphagia also charac-terized the course of illness. Family members intimated that the patient had lost 30 to 40 pounds over the previous month. Past medical history was significant for type 2 diabetes mellitus, aortic valve replacement, depression, osteoarthritis, andhyperlipidemia. The patient was a nonsmoker and did not consume alcohol. No history of chronic headaches, cerebrovascular accident, transient ischemic attack, and psychiatric or neurologic maladies was re