COCCIDIOIDOMYCOSIS IN LIVER-TRANSPLANT PATIENTS

Eight (0.59%) of 1,347 patients who underwent liver transplantation at the UCLA Medical Center (Los Angeles) developed coccidioidomycosis, W hereas only one case occurred during the first 8 years and 10 months o f the UCLA Liver Transplant Program (February 1984 to December 1992), seven cases occurred within the following 23-month period (December 19 92 to November 1994). The median time of onset for infection after tra nsplantation was 8 weeks (range, 4-312 weeks), Clinical presentations of patients with coccidioidomycosis included pneumonia (six cases), pn eumonia with meningitis (one case), hepatitis (one case), and monoarti cular arthritis (one case). Despite therapy with amphotericin B alone (six cases) or amphotericin B plus fluconazole (two cases), infection was fatal in four of eight cases, As of this writing, the four survivi ng patients are receiving chronic maintenance therapy with either fluc onazole (three patients) or itraconazole (one patient). These experien ces show that coccidioidomycosis can be a serious and frequently fatal infection after liver transplantation and that the incidence of this disease appears to be increasing.