Coccidioidomycosis (Cocci) is a fungal infection that is endemic to the southwestern United States.1 Although typically these infections are self-limited, in patients who are immunocompromised, these infections can be life-threatening. To date, only three cases of coccidioidomycosis following bone marrow transplantation (BMT) have been published in the literature.2 In each of these patients, there was no evidenc who developed disseminatee of active infection at the time of transplantation. Both patientsd coccidioidomycosis died secondary to infection and active disease has been seen as a potential contraindication to transplantation. We now report the first case of a patient with known evidence of active coccidioidomycosis prior to BMT who subsequently successfully underwent allogeneic transplantation.
A 24-year-old female resident of Phoenix, Arizona was diagnosed with MDS after she presented to the emergency room with acute respiratory and multi-organ failure in May 2000. Chest X-ray revealed bilateral pulmonary infiltrates and cultures obtained by bronchosocopy were positive for coccidioidomycosis. The patient was initially managed with conventional intravenous amphotericin but was intolerant, secondary to hyperpyrexia and delirium. Subsequently, she was treated with fluconazole (400 mg/day); however, 6 days after this therapy, she re-presented to the emergency room with chest discomfort, cough, low-grade fever and active evidence of cocci on CXR. She was hospitalized, treated with intravenous fluconazole (600 mg/day) and then discharged on maintenance therapy of fluconazole 400 mg/day orally. CT scan demonstrated improvement with residual nodules present. In August 2000, she was hospitalized with progression of her MDS to AML, with numerous cytogenetic abnormalities, including trisomy 13. CXR prior to chemotherapy demonstrated near-complete resolution of the previously seen infiltrates. She received chemotherapy with Ara C and Daunorubicin (7 and 3) and during the time of her neutropenia developed persistent fever, new infiltrates on CT scan, and evidence for active cocci on bronchosopy. She received therapy with fluconzaole and was referred to the BMT service.
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