FATAL MILIARY COCCIDIOIDOMYCOSIS COMPLICATING PROLONGED PREDNISONE THERAPY IN A PATIENT WITH MYELOFIBROSIS

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Abstract
The dangers of using adreno-corticotrophic hormone, hydrocortisone, and similar compounds in large doses over long periods have been clearly demonstrated during the last decade, particularly in the case of infections without concomitant antimicrobial therapy. However, disseminated coccidioidomycosis associated with prolonged adrenocortical steroid therapy has not previously been reported. This paper documents such an occurrence in a 37-year-old white female with a 7-year history of myelofibrosis, treated with prednisone for 8 months prior to death because of the development of thrombocytopenia and an acute hemolytic anemia. Miliary densities appeared on chest X-rays 3 weeks before her death, and she was assumed to have miliary tuberculosis, even at the time of the gross autopsy. It was not until microscopic and bacteriologic studies were completed that the correct diagnosis of disseminated coccidioidomycosis was made. This report, therefore, highlights the possible danger of acquisition, activation, or dissemination of coccidioidomycosis when steroid therapy is prolonged, and is considered to be the counterpart of observations recorded with reference to tuberculosis, histoplasmosis, and other infectious diseases.