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.


METHODS
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.


CONCLUSIONS
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.
Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seongbuk-gu, Seoul 136-705, Republic of Korea. pugae1@hanmail.net
Dae Won
DW
Park
Jang Wook
JW
Sohn
Hee Jin
HJ
Cheong
Woo Joo
WJ
Kim
Min Ja
MJ
Kim
Je Hyeong
JH
Kim
Chol
C
Shin
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D000077336:Caspofungin; D003047:Coccidioidomycosis / Q000188:drug therapy* / Q000473:pathology; D004359:Drug Therapy, Combination; D054714:Echinocandins; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D007723:Korea; D055666:Lipopeptides; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000473:pathology; D008297:Male; D010456:Peptides, Cyclic / Q000627:therapeutic use*; D011014:Pneumonia / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D015725:Fluconazole; D000077336:Caspofungin