BLASTOMYCOSIS DETECTED BY MICROBIAL CELL-FREE DNA IN RENAL TRANSPLANT RECIPIENT

68-year-old male with past medical history of kidney transplant (3 years ago) and diabetes mellitus presented with fever, shortness of breath, and productive cough for one month. He was on tacrolimus, mycophenolate, prednisone, and trimethoprim-sulfamethoxazole. He was afebrile, tachycardic, tachypneic and on high-flow oxygen. He was using accessory muscles to breathe. White cell count was 12,000 cells/mm3 (90% neutrophils). Serum creatinine was 2.25 mg/dL (baseline: 1.2 mg/dL). Electrolytes were normal.