Extracorporeal membrane oxygenation for overwhelming Blastomyces dermatitidis pneumonia

Blastomyces dermatitidis is a fungus that is found primarily in endemic areas of the midwestern and southcentral USA. Blastomycosis pneumonia may develop after the inhalation of spores. While blastomycosis may lead to acute or chronic pneumonitis, it will rarely result in the development of the acute respiratory distress syndrome (ARDS). In this situation, mortality rates are 50–80%. Patients who survive, however, commonly show good recovery of pulmonary function. Extracorporeal membrane oxygenation (ECMO), a modified form of cardiopulmonary bypass that allows systemic perfusion, oxygenation, and carbon dioxide removal, may be used to support patients with cardiorespiratory failure that is refractory to conventional therapies. The use of ECMO allows the reduction of high levels of mechanical ventilatory support that may cause iatrogenic injury to the diseased lung. Fungal diseases are often contraindications for ECMO use, since systemic fungal organisms may bind to the ECMO circuit and be difficult to eradicate. It may be reasonable to utilize ECMO, however, if the fungal infection is isolated to the respiratory system. We report the case of a patient with ARDS secondary to blastomycosis pneumonia who was treated with ECMO due to the failure of conventional cardiorespiratory supports. To our knowledge, this is the first report of the use of ECMO for this condition. Addresses: Department of Pediatrics, Division of Pediatric Critical Care Medicine, *Department of Surgery, Division of Cardiothoracic Surgery, and †Department of Pathology, Georgetown University Medical Center, Washington DC, USA