Multi‐organ failure caused by reactivated coccidioidomycosis without dissemination in a patient with renal transplantation

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Abstract
Objective: The acute respiratory failure caused by pulmonary coccidioidomycosis without dissemination is an extremely unusual event. Case Report: We report a 47‐year‐old renal transplanted man with a reactivated pulmonary coccidioidomycosis, whose clinical course presented as fulminant respiratory failure, disseminated intravascular coagulation and profound hypotension mimicking bacterial pneumonia and septic shock. Lung biopsy showed conglomerated necrotizing granulomas containing many spherules filled with endospores of Coccidioides immitis. Conclusion: Coccidioidomycosis should be included in the differential diagnosis of acute sepsis, particularly in an immunocompromised host who has travelled in an endemic area.