The diagnosis of paracoccidioidomycosis was made in the case of a hospitalized patient in New Orleans. The biopsy showed multiple budding and variations in fungus cell size. In the hematoxylin-eosin sections, the budding was not obvious and the first suggestion offered was that it was North American blastomycosis. The Grocott-Gomori methenamine silver stain demonstrated the multiple budding and variation in cell size to better advantage. Cultures revealed Paracoccidioides brasiliensis, skin tests were positive to paracoccidiodin, and results of serologic tests were positive. The patient had worked in South America for a number of years, though he was a native of the United States.