The Brief Case: A Fatal Case of SARS-CoV-2 Coinfection with Coccidioides in Texas-Another Challenge We Face.

Abstract

A 52-year-old Hispanic male who lived in Lynn County, Texas, with obesity (BMI 33) and poorly controlled diabetes mellitus (glycosylated hemoglobin, >12%; range, 4.0 to 5.9%) presented to the emergency room (ER) at an outside hospital with shortness of breath, cough, decreased appetite, and fever for 4 days. He was found with acute hypoxic respiratory failure and was airlifted to one of our satellite hospitals because no hospital beds were available in the patient’s living area. He tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive by ID Now COVID-19 assay (Abbott, Abbott Park, IL, USA) and was diagnosed with severe COVID-19 and diabetic ketoacidosis. In the intensive care unit (ICU), he initially required noninvasive positive pressure ventilation with bilevel positive-airway pressure (BiPAP) but decompensated and required escalation to endotracheal intubation and mechanical ventilation by the second hospital day (HD). Chest radiographs were consistent with multifocal pneumonia; bilateral patchy and hazy opacities were seen throughout the lungs and were more prominent on the right side (Fig. 1A). Successive radiographs showed progressive worsening of multifocal opacities and infiltrates throughout the lung fields and developing pleural effusions, culminating in severe bilateral interstitial and alveolar airspace opacities on HD 19 (Fig. 1B).