Otitis media due to blastomycosis: report of two cases. Clin. Infect. Dis

Blastomycosis as a causative agent in cases of otitis media has not previously been reported. Two patients recently presented with otitis media and head and neck masses due to Blastomyces dermatitidis. Initial evaluation suggested neoplastic disease, but biopsy confirmed a fungal etiol-ogy for the masses in both patients. Relapse after administration of ketoconazole was noted in one patient, who was an adult; the other patient was a child. Otitis media and masses of the head and neck are unusual features of blastomycosis. Blastomycosis should be considered in the differ-ential diagnosis for patients with such mass lesions and for patients with otitis media. Blastomyces dermatitidis, the causative agent of biastomy-cosis, is a dimorphic fungus endemic in the south central and Great Lakes regions of the United States. The organism is inhaled and may disseminate hematogenously from the lung throughout the body, thus causing a wide spectrum of symp-toms. We present two cases ofdisseminated infection involv-ing a site not previously reported, the middle ear. Case Report