A Rare Case of Coccidioidomycosis Meningitis

Abstract

Disseminated coccidioidomycosis is a fungal disease endemic to the Southwest United States as well as South and Central America. This dimorphic fungus typically manifests as pulmonary infection; however, there are very rare instances of extrapulmonary disseminated disease especially in immunocompromised hosts. Here, we present a 46-year-old immunocompromised patient with a recent diagnosis of pulmonary coccidioidomycosis that initially presented with acute respiratory failure and was found to have coccidioidomycosis meningitis. This case highlights that despite early and adequate treatment of a known pulmonary coccidioidomycosis infection, dissemination of the disease can still ensue and should be considered in cases of acute encephalopathy.

Keywords: Coccidioidomycosis; Disseminated; Fungal infection; HIV; Immunocompromised.

Figure 1

Computed tomography (CT) scan of the head with intravenous (IV) contrast, showing focal hemorrhage versus enhancing mass (blue arrow) involving the genu of the corpus callosum measuring 1.1 × 1.8 × 3.9 cm.

Figure 2

Magnetic resonance imaging (MRI) of the brain without intravenous (IV) contrast, showing large hemorrhagic mass extending across the splenium of the corpus callosum measuring 4.7 cm (red arrow) with surrounding edema.