Solution: Pulmonary disease is the most common manifestation of systemic infection with blastomysosis. Blastomycosis is caused by the fungus Blastomyces dermatitidis and is a potentially fatal systemic and cutaneous infection. Appears to be endemic to the soil and is often seen in patients who have been exposed to decaying wood, organic materials, and/or excavations. Acute and chronic pneumonia are differentiated and can have different symptoms, along the spectrum on infectious symptoms such as fever, chest pain, and myalgias, through cough, weight loss and hemoptysis. It is often misdiagnosed initially as a community acquired pneumonia, malignancy, and even tuberculosis. Correct diagnosis can be made by recognizing the constellation of findings and performing sputum evaluation or tissue sampling.