Abstract
A 47-yr-old white woman developed several reactivations of pulmonary foci progressing to cavitation due to Coccidioides immitis. This sequence occurred in the presence of unreactivity to intradermal coccidioidin and unresponsiveness of the patient's lymphocytes in vitro to this antigen. This immunological defect was specific for C. immitis, as the patient was otherwise immunologically normal by several criteria including intradermal testing with other antigens and a normal response of her lymphocytes in vitro to phytohemagglutinin. Immunologic reconstitution was attempted several times with whole leukocytes and with leukocyte extracts (transfer factor). Conversion to intradermal reactivity to coccidioidal antigens was achieved with transfer factor, though the persistence of intradermal reactivity could only be demonstrated with spherulin, a new C, immitis skin-test antigen, and specific lymphocyte reactivity in vitro could not be shown. The patient's disease stabilized for several months, but the overall therapeutic effect of these immunological interventions is not yet certain.
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