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doi:10.1378/chest.07-2778
(Chest. 2008; 133:1478-1480)
© 2008 American College of Chest Physicians
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Corticosteroids for Blastomycosis-Induced ARDS*

A Report of Two Patients and Review of the Literature

Tim Lahm, MD; Sheila Neese, MD; Aaron T. Thornburg, DO; Michael D. Ober, MD; George A. Sarosi, MD, FCCP and Chadi A. Hage, MD, FCCP

* From the Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Occupational Medicine (Drs. Lahm, Thornburg, and Ober), Division of Infectious Diseases (Dr. Neese), and Roudebush VA Medical Center (Drs. Sarosi and Hage), Indiana University School of Medicine, Indianapolis, IN.

Correspondence to: Tim Lahm, MD, 1481 W Tenth St, VA 111P-IU, Indianapolis, IN 46202; e-mail: tlahm{at}iupui.edu

ARDS secondary to blastomycosis is associated with a high mortality rate despite appropriate antifungal therapy. Corticosteroids are of proven benefit in the treatment of severe Pneumocystis jiroveci pneumonia and are recommended for the treatment of severe pulmonary infections with Histoplasma capsulatum. However, their role in the treatment of severe pulmonary infections with Blastomyces dermatitidis has not been established. We report the cases of two previously healthy men who presented with severe ARDS secondary to blastomycosis. Refractory hypoxemia developed in both patients despite adequate antifungal coverage with amphotericin B. Dramatic improvement was seen in each patient after initiation of corticosteroids in addition to amphotericin B. Both patients survived and did well on follow-up. We suggest that treatment with corticosteroids may be of benefit in patients with blastomycosis-induced ARDS. This may be due to a decrease in the severity of the inflammatory response.

Key Words: acute lung injury • Blastomyces dermatitidis • Histoplasma capsulatum • methylprednisolone • systemic inflammatory response syndrome






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