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Background  Blastomycosis is a fungal infectious disease prevalent in North America and rarely reported in Asia. Misdiagnosis of malignancy and other infectious diseases were reported.    Case presentation  A 24-years-old male patient presented with chronic non-productive cough of 4 months duration. He had been diagnosed with  Mycobacterium tuberculosis  infection and lung malignancy elsewhere and presented to us as the symptoms persisted. We offered him the biopsy under endobronchial ultrasound-guide sheath-transbronchial lung biopsy and sample specimen were sent for next generation sequencing analysis, returned as  Blastomyces Dermatitidis  infection. The patient was treated by itraconazole for 6 months, his symptoms decreased significantly and the CT scan showed resolution of the lesion.    Conclusion  We shared a case of blastomycosis with delayed and difficult diagnosis and reviewed the knowledge regarding differential diagnosis and next generation sequencing technologies.

A young male with chronic nonproductive cough diagnosed with blastomycosis in China: a case report