Acute eosinophilic pneumonia complicating Coccidioides immitis pneumonia: a case report and literature review.

Though peripheral eosinophilia commonly accompanies infection with Coccidioides immitis, pulmonary eosinophilia in patients with C. immitis and multilobar infiltrates has been reported in only three prior cases to our knowledge. To enhance clinicians' suspicion of an unusual complication of C. immitis pneumonia and the treatment implications, we present a patient with an initial diagnosis of acute eosinophilic pneumonia [based on bronchoalveolar lavage (BAL) fluid analysis and transbronchial biopsy] followed several days later by a diagnosis of accompanying C. immitis pneumonia when BAL fluid cultures grew fungus. In keeping with the suspicion of acute eosinophilic pneumonia, the patient responded dramatically to corticosteroids before antifungal therapy was initiated. This patient with pulmonary eosinophilia complicating C. immitis pneumonia extends earlier reports of a hypersensitivity-like reaction to C. immitis pneumonia and, based on the dramatic acute clinical response, reminds clinicians of the potential adjunctive role of corticosteroids. At the same time, the possible adverse effects of using corticosteroids in patients with fungal disease warrants caution and close follow-up in patients for whom steroids are prescribed.