title: Multi-organ failure caused by reactivated coccidioidomycosis without dissemination in a patient with renal transplantation.
abstract: OBJECTIVE
  The acute respiratory failure caused by pulmonary coccidioidomycosis without dissemination is an extremely unusual event.
  
  
  METHODS
  We report a 47-year-old renal transplanted man with a reactivated pulmonary coccidioidomycosis, whose clinical course presented as fulminant respiratory failure, disseminated intravascular coagulation and profound hypotension mimicking bacterial pneumonia and septic shock. Lung biopsy showed conglomerated necrotizing granulomas containing many spherules filled with endospores of Coccidioides immitis.
  
  
  CONCLUSIONS
  Coccidioidomycosis should be included in the differential diagnosis of acute sepsis, particularly in an immunocompromised host who has travelled in an endemic area.
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: J M
authors.initials: JM
authors.lastname: Cha
authors.forename: S
authors.initials: S
authors.lastname: Jung
authors.forename: H S
authors.initials: HS
authors.lastname: Bahng
authors.forename: C M
authors.initials: CM
authors.lastname: Lim
authors.forename: D J
authors.initials: DJ
authors.lastname: Han
authors.forename: J H
authors.initials: JH
authors.lastname: Woo
authors.forename: Y
authors.initials: Y
authors.lastname: Koh
mesh_terms: D003047:Coccidioidomycosis / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation / Q000276:immunology; D008172:Lung Diseases, Fungal / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D012772:Shock, Septic / Q000209:etiology