Severe Pulmonary Coccidioidomycosis Treated With Systemic Corticosteroids in an Adolescent Child.

Coccidioidomycosis (CM) is an emerging public health challenge due to an increasing number of cases in the U.S. Diagnosis may be challenging because of its nonspecific presentation, which may lead to treatment delays. In addition, the optimal management of severe pulmonary CM remains unclear. We present the case of an 18-year-old immunocompromised renal transplant recipient with a history of systemic lupus erythematosus who developed acute respiratory distress syndrome (ARDS) secondary to severe pulmonary CM. Following initiation of systemic corticosteroids treatment with standard-of-care antifungals, she demonstrated improved clinical response. Severe pulmonary CM may lead to a significant multiorgan inflammatory response in this infection. Our case explores corticosteroid treatment to downregulate this pathophysiologic process and help facilitate clinical resolution of the critical respiratory symptoms and limit morbidity associated with this infection.