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The incidence of coccidioidomycosis — commonly known as valley fever — has been dramatically increasing in Arizona and California in recent years. Although disseminated disease is rare, outcomes can be devastating, and there is no standard antifungal therapy. Combination therapy with an azole antifungal plus the echinocandin caspofungin has shown efficacy for infections caused by Candida and Aspergillus. Now, investigators describe the management of nine pediatric cases of complicated coccidioidomycosis in which initial antifungal therapy failed and voriconazole plus caspofungin was subsequently used.
At presentation, the patients were from 2 months to 18 years old. Three had extrathoracic disease; the others had severe pulmonary disease, in…