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. 2017 Mar 23:16:8-11.
doi: 10.1016/j.mmcr.2017.03.003. eCollection 2017 Jun.

Coccidioidal meningitis complicated by central nervous system vasculitis in a patient with leukemia

Dany Tager  1 , Anne Hatch  2 , Jennifer Segar  3 , Brentin Roller  4 , Mayar Al Mohajer  4 , Tirdad T Zangeneh  4
Affiliations

Coccidioidal meningitis complicated by central nervous system vasculitis in a patient with leukemia

Dany Tager et al. Med Mycol Case Rep. .

Abstract

Central Nervous System (CNS) vasculitis is the most common life-threatening complication of coccidioidal meningitis. It is manifested by cerebral ischemia, hemorrhage, and infarction. We report a case of CNS vasculitis in a patient receiving chemotherapy and review of the literature on coccidioidal meningitis. The patient was treated with combination antifungal therapy and a short course of high dose corticosteroids with a modest improvement in her neurological examination after initiation of steroids.

Keywords: Cerebral vasculitis; Coccidioidal meningitis; Disseminated coccidioidomycosis; Fungal meningitis; Steroid.

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Figures

Fig. 1
Fig. 1
Axial diffusion weighted MR images show restricted diffusion in multiple vascular distributions within the brain consistent with infarctions.
Fig. 2
Fig. 2
Axial fluid-attenuated inversion recovery MR image demonstrates (A) bilateral but asymmetric cortical/subcortical and basal ganglia hyperintensities. (B) Focal lesions show high signal foci that have a typical peripheral hypointense rim.
Fig. 3
Fig. 3
Axial T1-weighted gadolinium -enhanced MR image shows characteristic (A) diffuse enhancing basilar leptomeninges (white thin arrows) and (B) ring-like and irregular enhancement of focal lesions (thick white arrows).
Fig. 4
Fig. 4
CT Angiogram illustrates caliber variation of several intracranial vessels, most specifically M2 branches of the left middle cerebral artery (white arrow) indicative of vasculitis.
See this image and copyright information in PMC

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