Combination therapy of disseminated coccidioidomycosis with caspofungin and fluconazole
1 Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, 126-1, Anam-dong 5th Str., Seongbuk-gu, Seoul 136–705, Republic of Korea
2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
BMC Infectious Diseases 2006, 6:26 doi:10.1186/1471-2334-6-26Published: 15 February 2006
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.
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.
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.