A Brazilian immigrant is hired at a meat packing plant and undergoes a physical examination. Chest X-ray demonstrates a patchy bilateral pneumonia and a lung mass. Biopsy of the mass demonstrates fungal organisms with a few very distinctive ‘ pilot’s wheel’ yeast forms. What is the most likely diagnosis-
a. South American blastomycosis or paracoccidoidomycosis is primarily a pulmonary infection that disseminates to a chronic granulomatous mucosal infection
b. Stained tissue sections show yeast cells (2-30 µ) with multiple buds: Pilot wheel or Mariner’s wheel appearance
c. Culture on SDA/YPA/BHIA after 2-3 wks- hyaline septate hyphae with microconidia and arthrospores.