Fatal septic shock due to disseminated coccidioidomycosis: a case series and review of the literature

Piotr Wisniewski, Isaac McCool, John C. Walsh, Chelsea Ausman, Jenifer Edmondson, Alexandra Perry, Evan C. Ewers, Ryan C. Maves*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Coccidioidomycosis is a fungal infection endemic to the southwestern United States and regions of Latin America. Disseminated disease occurs in < 1% of cases. Septic shock is even rarer, with high mortality despite therapy. Case summary: We describe two cases of coccidioidal septic shock. Both patients were older men of Filipino ancestry presenting with respiratory failure and vasopressor-dependent shock. Antifungal drugs were initiated after failure to improve with empiric antibiotics; in both, Coccidioides was isolated from respiratory cultures. Despite aggressive care, both patients ultimately died of their infections. We provide a review of the published literature on this topic. Conclusions: Most of the 33 reported cases of coccidioidal septic shock occurred in men (88%) of non-white race and ethnicity (78%). The overall mortality rate was 76%. All survivors received amphotericin B as part of their treatment. Coccidioidomycosis-related septic shock is a rare disease with poor outcomes; delays in diagnosis and treatment are common. Improved diagnostic testing for coccidioidomycosis could enhance recognition of this disease in the future. Although data are limited, early treatment with amphotericin B in cases of coccidioidal septic shock may reduce mortality.

Original languageEnglish
Article number430
JournalBMC Infectious Diseases
Volume23
Issue number1
DOIs
StatePublished - Dec 2023
Externally publishedYes

Keywords

  • Coccidioides
  • Coccidioidomycosis
  • Sepsis
  • Septic shock

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