A Case of Coccidioidal Meningitis.
- Author:
Jung Woo LEE
1
;
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
Author Information
- Publication Type:Case Report
- Keywords: Coccidioidomycosis; Meningitis; Intrathecal; Amphotericin B
- MeSH: Adult; Amphotericin B; Brain; Coccidioidomycosis; Dexamethasone; Diplopia; Fluconazole; Gait; Glucose; Headache; Humans; Hydrocephalus; Intracranial Pressure; Itraconazole; Leukocytosis; Mannitol; Meningitis; Neuroimaging; Ventriculoperitoneal Shunt; Vomiting
- From:Infection and Chemotherapy 2012;44(2):75-79
- CountryRepublic of Korea
- Language:Korean
- 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.
