Pulmonary sequestration with primary blastomycosis: Failure of ketoconazole therapy after resection

Infection with Blastomyces dermatitidis developed in a girl with occult pulmonary sequestration. Six months after resection, while receiving ketoconazole, she developed an abscess due to B dermatitidis over the scar from thoracotomy, with a sinus tract to the eighth rib. This was successfully managed with debridement, rib resection, and amphotericin B. Contiguous bone involvement should be suspected in sequestra infected with this organism: debridement and therapy with amphotericin B might be indicated.