Blastomyces dermatitidis is a dimorphic fungus endemic to Canada and the United States. Few reports regarding blastomycosis in Canada have been published. We retrospectively reviewed the medical charts of 143 patients with confirmed cases of blastomycosis diagnosed in hospitals in Manitoba, Canada, from 1988 through 1999. The annual incidence rate of blastomycosis in Manitoba was 0.62 cases per 100,000 population, compared with 7.11 cases per 100,000 population in the Kenora, Ontario district. The average age of patients was 38.0 years, and males accounted for 65.0% of cases. An increased incidence of blastomycosis was observed in the Aboriginal subpopulation. Organ systems involved were as follows: respiratory system (93.0% of cases), skin (21.0%), bone (13.3%), genitourinary tract (1.4%), and the central nervous system (1.4%); 6.3% of patients died, and death was associated with a short clinical course. This study provides a summary of the current status of blastomycosis in this area of endemicity in Canada.

A 66-year-old woman receiving warfarin for the past 8 years after replacement of her aortic root and aortic valve sustained a left-breast injury with a wringer washing machine. While manually feeding clothes through the rollers of her wringer washing machine, her left breast was drawn into the rollers when her blouse became entangled with the clothing she was wringing. The patient was not wearing a brassiere. Her husband immediately responded to her cries for help by disconnecting the electricity to the washing machine and pressing the emergency release for the rollers. This washing machine was immediately discarded. The patient sought emergency medical attention within 10 hours of the accident with a bruised, painful, and markedly swollen left breast. Obvious injury could not be detected, and silver sulfadiazine cream was applied to a small superficial abrasion. Within 7 days, fevers and chills developed, and clindamycin was prescribed. Despite 2 days of this therapy, there was no improvement. The patient presented to a local emergency department, where physical examination revealed a well-looking female patient whose left breast was markedly larger than the right. A large ecchymotic and erythematous area affecting the lateral aspect of the left breast was present. This area was fluctuant and tender, with an eschar over the superior lateral aspect of the breast (Fig.