皮质类固醇在严重球孢子菌病治疗中的应用。

Corticosteroids in the Management of Severe Coccidioidomycosis.

机构信息

Pulmonary, Critical Care and Sleep Section, Infectious Diseases Section, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, Calif.

出版信息

Am J Med. 2019 Jan;132(1):110-113. doi: 10.1016/j.amjmed.2018.09.020. Epub 2018 Oct 2.

DOI:10.1016/j.amjmed.2018.09.020

PMID:30290191

Abstract

BACKGROUND

There is limited data suggesting that recovery from severe pulmonary infection with Coccidioides may be hastened by the addition of systemic corticosteroids.

METHODS

We present a case report of 2 patients with persistent and progressive coccidioidomycosis who demonstrated a dramatic response to adjunctive corticosteroid therapy.

RESULTS

Both patients had Coccidioides immitis cultured from respiratory samples. One was a 69-year-old man who had been treated with combination fluconazole and liposomal amphotericin for over 6 weeks, with persistent fever and pneumonia. The other was a 61-year-old man treated with fluconazole and then amphotericin for 3 weeks, with progression to acute respiratory distress syndrome and shock. Both received short courses of intravenous methylprednisolone and recovered to be discharged home.

CONCLUSIONS

As opposed to associated hypersensitivity, corticosteroid treatment in these cases was directed at modulating the ongoing destructive effects of unchecked inflammation. Rapid improvement was noted in both cases and raises the possibility that the addition of systemic corticosteroids may hasten recovery in patients with severe coccidioidomycosis.

摘要

背景

有有限的数据表明，全身性皮质类固醇的添加可能会加速严重肺部真菌感染的恢复。

方法

我们报告了 2 例持续性和进行性球孢子菌病患者的病例报告，他们对辅助皮质类固醇治疗有明显反应。

结果

两名患者的呼吸道样本中均培养出了 Coccidioides immitis。一名是 69 岁男性，已接受联合氟康唑和脂质体两性霉素 B 治疗超过 6 周，持续发热和肺炎。另一名是 61 岁男性，用氟康唑和两性霉素 B 治疗 3 周，进展为急性呼吸窘迫综合征和休克。两人均接受了短期静脉注射甲基强的松龙治疗，并康复出院。