Corticosteroids for blastomycosis-induced ARDS: a report of two patients and review of the literature.
ARDS secondary to blastomycosis is associated with a high mortality rate despite appropriate antifungal therapy. Corticosteroids are of proven benefit in the treatment of severe Pneumocystis jiroveci pneumonia and are recommended for the treatment of severe pulmonary infections with Histoplasma capsulatum. However, their role in the treatment of severe pulmonary infections with Blastomyces dermatitidis has not been established. We report the cases of two previously healthy men who presented with severe ARDS secondary to blastomycosis. Refractory hypoxemia developed in both patients despite adequate antifungal coverage with amphotericin B. Dramatic improvement was seen in each patient after initiation of corticosteroids in addition to amphotericin B. Both patients survived and did well on follow-up. We suggest that treatment with corticosteroids may be of benefit in patients with blastomycosis-induced ARDS. This may be due to a decrease in the severity of the inflammatory response.
Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN. Electronic address: tlahm@iupui.edu.
Tim
T
Lahm
Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN.
Sheila
S
Neese
Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN.
Aaron T
AT
Thornburg
Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN.
Michael D
MD
Ober
Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN.
George A
GA
Sarosi
Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN.
Chadi A
CA
Hage
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001759:Blastomycosis / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011175:Positive-Pressure Respiration; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000628:therapy
D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents