Correct!
1. Corticosteroids

He was begun on methylprednisolone 60 mg IV daily. He had marked clinical improvement. A subsequent chest radiograph after 4 days demonstrated improvement (Figure 6).

Figure 6. Chest x-ray done on 11/18.

After an additional 5 days of treatment, he was saturating well on room air and was able to be discharged to home. There are only a few case reports of corticosteroid therapy being clinically beneficial in severe pulmonary cocci (5,6). The proposed mechanism is similar to that proposed in some other infections (PJP, ?Covid-19) in which an excessive inflammatory response is suppressed.

The above should not be considered an endorsement of corticosteroid usage in Valley Fever. Anecdotal reports of benefits of corticosteroids have been seen with other diseases. However, when subjected to investigation corticostoids did not prove to be beneficial. At this juncture with such limited data corticosteroids might be a consideration when a patient is doing poorly.

References

  1. Pahal P, Rajasurya V, Sharma S. Typical Bacterial Pneumonia. 2020 Aug 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. [PubMed]
  2. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. [CrossRef] [PubMed]
  3. CDC. Valley Fever (Coccidioidomycosis) Statistics. Available at: https://www.cdc.gov/fungal/diseases/coccidioidomycosis/statistics.html (accessed 11/28/20).
  4. Shibli M, Ghassibi J, Hajal R, O'Sullivan M. Adjunctive corticosteroids therapy in acute respiratory distress syndrome owing to disseminated coccidioidomycosis. Crit Care Med. 2002 Aug;30(8):1896-8. [CrossRef] [PubMed]
  5. Chang MR, Chopra N, Beenhouwer D, Goetz MB, Hoo GWS. Corticosteroids in the Management of Severe Coccidioidomycosis. Am J Med. 2019 Jan;132(1):110-113. [CrossRef] [PubMed]

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