title: Coccidioidomycosis in adolescents with lupus nephritis.
abstract: Coccidioidomycosis, a fungal infection endemic in the southwestern United States, can cause life-threatening infections in immunosuppressed patients. We report the contrasting cases of two adolescents with lupus nephritis, treated with intravenous pulse cyclophosphamide and daily oral corticosteroids, who developed pulmonary coccidioidomycosis. One patient developed a fatal form of fulminant disseminated coccidioidomycosis, while the other patient developed a solitary pulmonary Coccidioides immitis abscess which was responsive to intravenous liposomal amphotericin and fluconazole therapy. Because serologies and initial X-ray studies can be negative, definitive diagnostic studies including bronchoaveolar lavage and needle aspiration should be performed when there is clinical suspicion of coccidioidomycosis in an immunocompromised patient. Immunosuppressed patients with coccidioidomycosis should receive early intravenous amphotericin therapy and may benefit from long-term suppressive antifungal therapy to prevent relapse.
authors.affiliation: Department of Pediatrics, Stanford University, Stanford, California, USA. pyorgin@stanford.edu
authors.forename: P D
authors.initials: PD
authors.lastname: Yorgin
authors.forename: M
authors.initials: M
authors.lastname: Rewari
authors.forename: A Y
authors.initials: AY
authors.lastname: al-Uzri
authors.forename: A A
authors.initials: AA
authors.lastname: Theodorou
authors.forename: K M
authors.initials: KM
authors.lastname: Scott
authors.forename: L L
authors.initials: LL
authors.lastname: Barton
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D000284:Administration, Oral; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000666:Amphotericin B / Q000627:therapeutic use; D002648:Child; D003047:Coccidioidomycosis / Q000139:chemically induced / Q000150:complications* / Q000188:drug therapy; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007275:Injections, Intravenous; D008081:Liposomes; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D008181:Lupus Nephritis / Q000150:complications* / Q000188:drug therapy; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D008081:Liposomes; D000666:Amphotericin B; D003520:Cyclophosphamide; D015725:Fluconazole