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June 28, 1993

Unrecognized Coccidioidomycosis Complicating Pneumocystis carinii Pneumonia in Patients Infected With the Human Immunodeficiency Virus and Treated With Corticosteroids: A Report of Two Cases

Author Affiliations

From the Department of Internal Medicine, University of Arizona Health Sciences Center, Tucson (Drs Mahaffey, Hippenmeyer, Mandel, and Ampel); and Medical Service, Tucson Veterans Affairs Medical Center (Drs Mahaffey and Ampel).

Arch Intern Med. 1993;153(12):1496-1498. doi:10.1001/archinte.1993.00410120076010

Coccidioidomycosis is becoming increasingly recognized as an opportunistic infection among patients infected with the human immunodeficiency virus. We treated two cases of concomitant coccidioidomycosis and Pneumocystis carinii pneumonia. In each case, the diagnosis of coccidioidomycosis was delayed despite appropriate examination of bronchoalveolar lavage fluid. Both patients were treated with antimicrobial therapy directed against P carinii and given adjuvant corticosteroid therapy. In both cases, this led to clinical worsening and was associated with the development of a reticulonodular pulmonary infiltrate on chest roentgenograms. When coccidioidomycosis and Pneumocystis pneumonia occur concomitantly in patients with human immunodeficiency virus infection, the diagnosis of coccidioidomycosis may be delayed or missed. In such cases, corticosteroids may lead to overwhelming coccidioidomycosis. Development of a reticulonodular pulmonary pattern on chest roentgenograms is suggestive of this complication.

(Arch Intern Med. 1993;153:1496-1498)