Primary nasal cutaneous blastomycosis in an immunocompetent patient from a nonendemic area

Infection with Blastomyces dermatitidis can take many forms and has been called the great pretender or the endemic mimic.1,2 Primary cutaneous blastomycosis can present as an exophytic, verrucous growth, a hyperkeratotic plaque, or an exudative ulcer. It has been misdiagnosed as pyoderma gangrenosum, verruca, squamous cell cancer, and keratoacanthoma.1,2 We present a primary intranasal and cutaneous case of blastomycosis, with subtle clinical findings, from an area where Blastomyces sp. is not known to be endemic.