Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Apr 1:2018:2176269.
doi: 10.1155/2018/2176269. eCollection 2018.

Myelitis due to Coccidioidomycosis in an Immunocompetent Patient

Tetyana Vaysman  1 , Sean Villaflores  1 , Carlyn Estrella  1 , Suman Radhakrishna  1 , Antonio Liu  1
Affiliations
Case Reports

Myelitis due to Coccidioidomycosis in an Immunocompetent Patient

Tetyana Vaysman et al. Case Rep Infect Dis. .

Abstract

Myelitis of the spinal cord is an uncommon presentation of disseminated coccidioidomycosis. Most infected patients present subclinically, but patients, especially those who are immunocompromised, may progress to disseminated disease. We present a 50-year-old immunocompetent patient with no significant past medical history exhibiting symptoms of altered mental status, dizziness, headache, nausea, and quadriplegia. Upon investigation with lumbar puncture, cerebrospinal fluid (CSF) culture, and coccidioidal antibody studies, the patient was found to have acute coccidioidomycosis. Magnetic resonance imaging (MRI) of the brain demonstrated meningeal enhancements suggestive of meningitis, and further MRI study of the cervical spine revealed myelitis. Treatment with IV fluconazole for 2 weeks and IV voriconazole therapy over 3 weeks yielded limited improvement. The presentation of myelitis due to coccidioidomycosis infection is very rare and has infrequently reported in the literature. Awareness of this potentially fatal complication in immunocompetent patients can aid in faster recognition and treatment.

PubMed Disclaimer

Figures

Figure 1
Figure 1
A sagittal T-weighted MRI of the C-spine of the patient on April 28, 2017, before the antifungal treatment. The arrows point to the spinal cord lesion due to coccidioidal infection.
Figure 2
Figure 2
A sagittal T-weighted MRI of the C-spine of the patient on May 22, 2017, after the antifungal treatment. The arrows point to the spinal cord lesion due to coccidioidal infection; however, the size of the lesion has decreased significantly in comparison to Figure 1.
See this image and copyright information in PMC

References

    1. Saubolle M. A., McKellar P. P., Sussland D. Epidemiologic, clinical, and diagnostic aspects of coccidioidomycosis. Journal of Clinical Microbiology. 2007;45(1):26–30. doi: 10.1128/jcm.02230-06. - DOI - PMC - PubMed
    1. Richard F. H., Rutherford G. W., Tsang C. A., et al. The public health impact of coccidioidomycosis in Arizona and California. International Journal of Environmental Research and Public Health. 2011;8(12):1150–1173. doi: 10.3390/ijerph8041150. - DOI - PMC - PubMed
    1. Galgiani J. N., Ampel N. M., Blair J. E., et al. Coccidioidomycosis. Clinical Infectious Diseases. 2005;41(9):1217–1223. doi: 10.1086/496991. - DOI - PubMed
    1. Kirkland T. N., Fierer J. Coccidioidomycosis: a reemerging infectious disease. Emerging Infectious Diseases. 1996;2(3):192–199. doi: 10.3201/eid0203.960305. - DOI - PMC - PubMed
    1. Ampel N. M. The complex immunology of human coccidioidomycosis. Annals of the New York Academy of Sciences. 2007;1111(1):245–258. doi: 10.1196/annals.1406.032. - DOI - PubMed

Publication types

LinkOut - more resources