CASE PRESENTATION: A 69 year-old Hispanic man with diabetes mellitus (HgbA1c 6.8) was admitted to an outside hospital with severe LLL pneumonia. He required intubation on hospital day (HD) 4. Coccidioidomycosis was diagnosed by positive IgM titers and growth of Coccidioides immitis from bronchoscopy. He started fluconazole and liposomal amphotericin (5 mg/kg/d). Anuric renal failure was attributed to sepsis and contrast nephropathy. Lumbar puncture, brain MRI and bone scan were negative. He required tracheostomy and gastrostomy tube placement with transfer to our hospital on HD 30. He completed 28 days of amphotericin and continued high dose fluconazole. Dialysis was discontinued on HD 38, but daily fevers continued. CT imaging demonstrated dense LLL > RLL consolidation and moderate pleural fluid. Thoracentesis on HD 46 was lymphocytic and exudative, with negative cultures. Intravascular catheters were removed, but fevers persisted. He transitioned to trach collar oxygen, but remained weak with evidence of critical illness polyneuropathy. Coccidioides continued to grow from sputum. On HD 48, methylprednisolone (40 mg/d decreasing 10 mg every three days to complete a 12 day course) was started. He quickly deferversced, cleared sputum Coddidioides, with radiographic and functional improvement. He transferred to a medical ward on HD 54, improved with physical therapy, and was discharged to a nursing home.