Chronic granulomatous disease in skin and pleural cavity caused by dimorphic fungus Blastomyccs dermatitidis; can mimic bronchogenic carcinoma. Disease occurs in central U.S., Canada, Central America, and Africa. Diagnosis is made by serum testing and Papanicolaou sputum smears. Treatment is itraconazole (mild-to-moderate disease) and amphotericin B (severe disease).