Meningeal coccidioidomycosis: Case report and literature review [Coccidioidomicosis meníngea: Reporte de caso y revisión de la literatura]

INTRODUCTION: Coccidioidomycosis is an infectious disease caused by the dimorphic fungus Coccidioidesimmitis, which remains a significant cause of sub-acute or chronic meningitis with a major prevalence in the North of Mexico. CASE REPORT: A 52-year-old male arrived to the emergency room for a cranial trauma. In the initial work-up with a head CT it was found an unexpected hydrocephalous. In the interrogatory we established that the patient had headache with an evolution of 2.5 years and had recently presented signs of intracranial hypertension. The evaluation was continued byperforming MRI and CSF analysis in search for the etiology, and a meningealbiopsy showed ovoid structures with spherules, containing numerous endospores positive for Grocott and PAS staining. Moreover, a granulomatous reaction with multinucleated giant cells was compatible with the diagnosis of meningeal coccidioidomycosis. We present a narrative review with systematic search on this topic. CONCLUSION: Coccidioidomycosis is still a current cause of CNS infection in patients living in the North of Mexico. The clinical manifestations consist in meningeal and cranial hypertension syndromes associated with an evolution of weeks to months, and it is required a high diagnostic suspicion. The opportune detection and antifungal treatment with amphotericin and fluconazole can improve symptoms and signs in up to 80%25 of patients. If untreated, meningeal coccidioidomycosis can be fatal.

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