Micafungin
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Lack of efficacy: case report A 65-year-old woman died due to diffuse pulmonary coccidioidomycosis despite antifungal therapy with micafungin. The woman had systemic lupus erythematous and end-stage renal disease. She had been receiving an unspecified immunosuppressant for systemic lupus erythematous and was on haemodialysis for end-stage renal disease. She presented with a 2-day history of pleuritic chest pain and fever. Laboratory investigation revealed pancytopenia and an elevated procalcitonin. A chest x-ray on admission demonstrated right lower lobe consolidation and bilateral pulmonary nodules and a CT angiography was found to be negative for pulmonary embolism. She was treated for suspected community-acquired pneumonia and her antibiotic coverage was immediately expanded due to worsening hypoxaemia, fever, tachycardia and dyspnoea. On day 5 of admission, a chest x-ray revealed increased pulmonary nodules and right lower lobe consolidation. Her sputum culture grew candida species and micafungin was therefore added to her treatment regimen. However, her clinical condition continued to worsen, and she was intubated for acute hypoxic respiratory failure. The woman received unspecified vasopressors for hypotension due to septic shock. She developed acute respiratory distress syndrome (ARDS), was ventilated after ARDSnet protocol, placed in prone position and paralysed. Despite all interventions and medical therapies, she died. Just hours after the death, her sputum culture and tracheal aspirate grew Coccidioides immitis, while other fungal serologies, including blastomycosis, histoplasmosis, cryptococcosis and tuberculosis were negative. Berenji N, et al. Valley fever in South Texas. American Journal of Respiratory and Critical Care Medicine 199: (plus poster) abstr. A6624, No. 9, May 2019. Available from: 803447681 URL: http://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A6624 [abstract]
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Reactions 18 Jan 2020 No. 1787
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