Infect Chemother.  2012 Apr;44(2):75-79. 10.3947/ic.2012.44.2.75.

A Case of Coccidioidal Meningitis

• Lee JW
• Kim SI
• Kim YJ
• Kwon JC
• Lim YJ
• Park MH
• Kim SA
• Koh ES
• Kim MJ
• Kang MW

• KMID: 2054440
• DOI: http://doi.org/10.3947/ic.2012.44.2.75

Abstract

A 35-year-old man with known coccidioidal meningitis developed a severe headache and vomiting during routine treatment. Hydrocephalus was visible on brain imaging, and CSF study revealed pleocytosis, lowering of glucose, and increased intracranial pressure. Dexamethasone and mannitol was used for intracranial pressure control. Intrathecal amphotericin B administration and switching to itraconazole resulted in gradual improvement of symptoms. After 4 months of discontinuing amphotericin B intrathecal administration, the patient developed severe headaches with vomiting, diplopia and tandem gait. Coccidioidal meningitis aggravation was suspected based on brain MRI and CSF studies. Ventriculo-peritoneal shunt insertion was performed for intracranial pressure control and the combined therapy of intrathecal amphotericin B administration and fluconazole was maintained. This combined regimen kept the meningitis stable for 1 month.

Keyword

Coccidioidomycosis; Meningitis; Intrathecal; Amphotericin B

MeSH Terms

Adult
Amphotericin B
Brain
Coccidioidomycosis
Dexamethasone
Diplopia
Fluconazole
Gait
Glucose
Headache
Humans
Hydrocephalus
Intracranial Pressure
Itraconazole
Leukocytosis
Mannitol
Meningitis
Neuroimaging
Ventriculoperitoneal Shunt
Vomiting
Amphotericin B
Dexamethasone
Fluconazole
Glucose
Itraconazole
Mannitol

Figure

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  Figure 1 Diffuse dilatation of all ventricles with peri-ventricular high signals was noticed on brain MRI.

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  Figure 2 Enlarged ventricle size is noticed, suspected hydrocephalus progression on brain MRI. Minimal meningeal enhancement is visible around brain stem. Also, small enhancing lesion at right pontomedullary junction is noticed.

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