pISSN 2093-2340   eISSN 2092-6448
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    Infect Chemother. 2012 Apr;44(2):75-79. Korean.
    Published online Apr 30, 2012.
    https://doi.org/10.3947/ic.2012.44.2.75
    Copyright © 2012 by The Korean Society of Infectious Diseases and Korean Society for Chemotherapy
    Case Report

    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 and 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, Email: kinfect@catholic.ac.kr
    Received June 18, 2011; Revised September 05, 2011; Accepted September 06, 2011.

    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

    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.

    Tables

    Table 1
    List of Admission Episodes

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    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
    Metrics
    Share
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