In a patient with fever, chills, sputum production, cough, and white exudates in the oral mucosa, which diagnosis is most likely?

• A. Pneumonia
• B. Blastomycosis
• C. Tuberculosis
• D. Viral pharyngitis

Answer: (B)

The symptoms presented—fever, chills, sputum production, cough, and white exudates in the oral mucosa—are suggestive of a more systemic infection, particularly one caused by a fungal organism. The presence of white exudates in the oral mucosa is particularly notable as it is often associated with fungal infections like candidiasis, which can occur in immunocompromised hosts or as a secondary complication of a primary infection.

When considering the possible diagnoses, blastomycosis stands out as it is a fungal infection caused by the organism Blastomyces dermatitidis, which is endemic to certain regions and can present with pulmonary symptoms such as cough and sputum production, alongside systemic symptoms like fever and chills. The oral manifestations, while not the most common primary presentation, can occur in disseminated forms of the disease.

Pneumonia and tuberculosis could share similar respiratory symptoms such as cough and fever, but they typically manifest without the specific oral exudates associated with fungal infections. Viral pharyngitis may present with fever and sore throat, but it would not typically cause sputum production or the described oral white exudates.

Thus, considering the combination of respiratory symptoms alongside unique oral findings, blastomycosis is the