Combination therapy of disseminated coccidioidomycosis with caspofungin and fluconazole

BACKGROUND: The current recommended therapy for diffuse coccidioidal pneumonia involves initial treatment with amphotericin B deoxycholate or high-dose fluconazole, followed by an azole after clinical improvement. Amphotericin B is more frequently used as initial therapy if the patient's deterioration is rapid. CASE PRESENTATION: A 31-year-old Korean male with coccidioidomycosis presented to the hospital with miliary infiltrates on chest X-ray (CXR) and skin rash on the face and trunk. Initially, the patient did not respond to amphotericin B deoxycholate therapy. However, following caspofungin and fluconazole combination therapy, the patient showed favourable radiological, serological, and clinical response. CONCLUSION: This appears to be the first case of diffuse coccidioidal pneumonia with skin involvement in an immunocompetent patient who was treated successfully with caspofungin and fluconazole. Combination therapy with caspofungin and fluconazole may, therefore, be an alternative treatment for diffuse coccidioidal pneumonia that does not respond to amphotericin B deoxycholate therapy

A fatal case of congenital pulmonary airway malformation with aspergillosis in an adult

Hilary A Enuh,1 Edward L Arsura,2 Zaza Cohen,3 Keith T Diaz,2 Jay M Nfonoyim,2 Phillip J Cosentino,2 Jessie K Saverimuttu4 1Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA; 2Pulmonary and Critical Care Medicine, Richmond University Medical Center, Staten Island, NY, USA; 3Pulmonary and Critical Care Medicine, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ, USA; 4Infectious Disease Control Unit, Richmond University Medical Center, Staten Island, NY, USA Abstract: Congenital cystic adenomatoid malformation, currently referred as congenital pulmonary airway malformation (CPAM), is one of the rare lung malformations seen in adults. We report a case of a 59-year-old male with a chronic cough and hemoptysis that was not amenable to bronchial embolization. Further work up revealed cystic changes with fungal ball and type 1 CPAM. Patients with this condition who survive to adulthood usually suffer from recurrent respiratory bacterial infections. Only three cases of fungal involvement have ever been described. We present a fatal case, as well as the oldest patient. Keywords: CPAM, aspergillosis, embolizatio