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Clinical Observation
January 10, 2005

Coccidioidomycosis in Patients With Hematologic Malignancies

Author Affiliations

Author Affiliations: Division of Infectious Diseases, Mayo Clinic, Scottsdale, Ariz (Drs Blair and Smilack), and Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (Dr Caples).

Arch Intern Med. 2005;165(1):113-117. doi:10.1001/archinte.165.1.113

Background  An endemic fungal infection of the desert southwestern United States, coccidioidomycosis is generally a self-limited illness in healthy persons. Immunosuppressed persons who contract coccidioidomycosis, however, are at increased risk for disseminated infection.

Methods  We conducted a retrospective review of patients with coccidioidomycosis and hematologic malignancy or bone marrow disease.

Results  Fifty-five patients were identified. The most common underlying malignancies were non-Hodgkin lymphoma and chronic lymphocytic leukemia. Extrathoracic (or disseminated) infection was observed in 12 patients (22%). Fifteen patients (27%) died with active coccidioidomycosis. Treatment of the hematologic disease with corticosteroids or antineoplastic chemotherapy increased the risk of death.

Conclusion  To date, this is the largest case series of patients with hematologic malignancy and coccidioidomycosis. In persons with hematologic malignancy, coccidioidomycosis can be a severe illness with a high risk for disseminated infection and death.

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