A case is presented of an otherwise healthy, middle-aged man who presented in Boston, Mass, with fever and cough and was initially diagnosed as having community-acquired pneumonia. Despite an outpatient course of azithromycin and then levofloxacin, he clinically worsened over 2 weeks, eventually developing acute respiratory distress syndrome. Alternative causes were then considered, with workup revealing severe pulmonary blastomycosis infection. Despite eventual appropriate antifungal therapy, he had advanced disease at the time of his delayed diagnosis and died because of complications of the infection. The patient’s presenting chest radiograph, potassium hydroxide preparation of bronchoscopy specimen, and silver stain of lung tissue with massive fungal disease burden are presented as clinical images.