Corticosteroids in the management of severe coccidioidomycosis.
Am J Med. 2018 Oct 02;:
Authors: Chang MR, Chopra N, Beenhouwer D, Goetz MB, Hoo GWS
BACKGROUND: There is limited data suggesting that recovery from severe pulmonary infection with Coccidioides may be hastened by the addition of systemic corticosteroids.
METHODS: A case report of two patients with persistent and progressive coccidioidomycosis who demonstrated a dramatic response to adjunctive corticosteroid therapy.
RESULTS: Both patients had Coccidioides immiitis cultured from respiratory samples. One was a 69 year old man who had been treated with combination fluconazole and liposomal amphotericin for over six weeks, with persistent fever and pneumonia. The other was a 61 year old man treated with fluconazole and then amphotericin for three weeks, with progression to acute respiratory distress syndrome and shock. Both received short courses of intravenous methylprednisolone and recovered to be discharged home.
CONCLUSION: As opposed to associated hypersensitivity, corticosteroid treatment in these cases was directed at modulating the ongoing destructive effects of unchecked inflammation. Rapid improvement was noted in both cases and raises the possibility that the addition of systemic corticosteroids may hasten recovery in patients with severe coccidioidomycosis.
PMID: 30290191 [PubMed - as supplied by publisher]