Abstract
We describe a case of life-threatening disseminated coccidioidomycosis in a previously healthy child. Like most patients with disseminated coccidioidomycosis, this child had no genomic evidence of any known, rare immune disease. However, comprehensive immunologic testing showed exaggerated production of interleukin-4 and reduced production of interferon-γ. Supplementation of antifungal agents with interferon-γ treatment slowed disease progression, and the addition of interleukin-4 and interleukin-13 blockade with dupilumab resulted in rapid resolution of the patient's clinical symptoms. This report shows that blocking of type 2 immune responses can treat infection. This immunomodulatory approach could be used to enhance immune clearance of refractory fungal, mycobacterial, and viral infections. (Supported by the Jeffrey Modell Foundation and the National Institutes of Health.).
Copyright © 2020 Massachusetts Medical Society.
Publication types
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Case Reports
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Research Support, N.I.H., Extramural
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Research Support, Non-U.S. Gov't
MeSH terms
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Antibodies, Monoclonal, Humanized / therapeutic use*
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Antifungal Agents / therapeutic use*
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Brain / diagnostic imaging
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Child, Preschool
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Coccidioidomycosis / drug therapy*
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Coccidioidomycosis / immunology
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Disease Progression
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Drug Therapy, Combination
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Humans
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Interferon-gamma / metabolism
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Interferon-gamma / therapeutic use*
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Interleukin-12 / metabolism
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Interleukin-13 / antagonists & inhibitors
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Interleukin-4 / antagonists & inhibitors
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Interleukin-4 / metabolism
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Magnetic Resonance Imaging
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Male
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Protein Isoforms
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Receptors, Interleukin-12 / chemistry
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Receptors, Interleukin-12 / genetics
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Spine / diagnostic imaging
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Th1 Cells / immunology
Substances
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Antibodies, Monoclonal, Humanized
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Antifungal Agents
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IL12RB1 protein, human
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Interleukin-13
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Protein Isoforms
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Receptors, Interleukin-12
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Interleukin-12
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Interleukin-4
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dupilumab
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Interferon-gamma