A Case of Coccidioidal Meningitis

Jung Woo Lee; Sang Il Kim; Youn Jeong Kim; Jae-Cheol Kwon; Ye Jee Lim; Mi Hee Park; Seon A Kim; Eun Sil Koh; Min Ju Kim; Moon Won Kang

doi:10.3947/ic.2012.44.2.75

Journal List > Infect Chemother > v.44(2) > 1035228

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Lee, Kim, Kim, Kwon, Lim, Park, Kim, Koh, Kim, and Kang: A Case of Coccidioidal Meningitis

Case Report

Infection & Chemotherapy

Infection & Chemotherapy 2012; 44(2): 75-79.

Published online: 30 April 2012

DOI: https://doi.org/10.3947/ic.2012.44.2.75

A Case of Coccidioidal Meningitis

Jung Woo Lee, Sang Il Kim, Youn Jeong Kim, Jae-Cheol Kwon, Ye Jee Lim, Mi Hee Park, Seon A Kim, Eun Sil Koh, Min Ju Kim, Moon Won Kang

Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Correspondence to Moon Won Kang, M.D. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Banpo-dong 505, Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-6001, Fax: +82-2-3477-9193, kinfect@catholic.ac.kr

Received 18 June 2011 Revised 5 September 2011 Accepted 6 September 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Coccidioidomycosis, Meningitis, Intrathecal, Amphotericin B

Figures and Tables

Figure 1

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

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.

Table 1

List of Admission Episodes

ITx, intrathecal.

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