Pulmonary blastomycosis is an uncommon late complication of solid organ transplantation. In this report, an uncommon case of pulmonary blastomycosis in a cardiac transplant recipient is presented, and three other cases in the literature are reviewed. Sputum analysis was performed in all the patients; however, bronchoalveolar lavage (BAL) obtained with bronchoscopy made the diagnosis in three of the four patients. In these three patients, blastomycosis was confined to the lung and had a favorable outcome when treated with anti-fungal medication. One patient with skin dissemination had a relapse despite adequate therapy with antifungal medication. In endemic regions, pulmonary blastomycosis must be included in the differential diagnosis of pulmonary infiltrates in cardiacm transplant recipients. Early bronchoscopy to obtain a respiratory specimen should be considered if sputum analysis is inconclusive, negative, or not possible. Outcome for blastomycosis limited to the lungs treated with antifungal medication is favorable. Patients with extrapulmonary blastomycosis may benefit with chronic maintenance therapy.