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Open Access Case report

Fatal miliary Coccidioidomycosis in a patient receiving infliximab therapy: a case report

Mark P Rogan* and Karl Thomas

Author Affiliations

Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA

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Journal of Medical Case Reports 2007, 1:79  doi:10.1186/1752-1947-1-79

Published: 5 September 2007

Abstract

A 78-year-old white male from Iowa in the United States of America receiving the anti- tumor necrois factor (TNF) agent infliximab therapy for rheumatoid arthritis developed a cheek ulcer which failed to respond to empiric antibiotic therapy. He subsequently presented with progressive respiratory failure from miliary coccidioidomycosis which proved fatal. The patient vacationed in Arizona 6 months previously and likely contracted the organism there as Iowa is not an endemic area for coccidioidomycosis. Respiratory failure from miliary infiltration is an uncommon presentation of coccidioidomycosis. Physicians should be aware of the importance of travel history and potential for life-threatening coccidioidomycosis in patients receiving tumor necrosis factor inhibitors.