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A 4-year-old child was found to have multisite disseminated coccidioidomycosis that was unresponsive to antifungal therapy and only partially responsive to interferon-γ (IFN-γ) treatment. A search for an underlying etiology revealed no specific genetic mutations, but mononuclear cells from the patient's blood after stimulation with coccidioidal antigen produced an excess of interleukin-4 (IL-4) compared with IFN-γ.
Because of this finding, dupilumab, a monoclonal antibody directed at IL-4, was administered in combination with IFN-γ and antifungals. Soon thereafter, the patient had remarkable clearing of all the lesions, and coccidioidal serology titers declined. The patient was also found to have an allelic imbalance for the gene encoding IL…