SHM Converge Scientific Abstract ePoster Gallery-A Lone Star Enigma: Blastomycosis Meningoencephalomyelitis After Environmental Exposures in Texas

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This case report describes a 72-year-old woman from Texas with hypertension and type 2 diabetes who developed headaches, diplopia, ataxia, confusion, and possible seizures after environmental exposures, including farm work, bush hogging, and a Native American sweat lodge ritual. Initial head CT was normal, but brain MRI showed white matter abnormalities and later diffuse leptomeningeal enhancement. Cerebrospinal fluid revealed lymphocytic pleocytosis, high protein, and low glucose, findings that initially raised concern for neurosarcoidosis or infectious meningitis. She was treated empirically with antibiotics, acyclovir, and high-dose steroids before CSF testing returned positive for Blastomyces antibody. She was then started on liposomal amphotericin B with plans for prolonged oral azole therapy.<br /><br />The report highlights that blastomycosis, a dimorphic fungal infection usually linked to endemic regions such as the Mississippi and Ohio River valleys and the Great Lakes, may be appearing in new geographic areas including Texas. Although blastomycosis most often affects the lungs, it can rarely cause isolated central nervous system disease. This form is especially uncommon, frequently occurs in immunocompetent patients, and can mimic inflammatory disorders such as neurosarcoidosis because imaging and CSF findings overlap.<br /><br />The authors emphasize that careful environmental and social history is critical in atypical neurologic presentations. They also note that ritual exposures such as sweat lodge use may represent overlooked sources of infection. Early recognition and appropriate antifungal therapy are essential, as CNS blastomycosis can present with meningitis, mass-like lesions, or spinal involvement and may be difficult to diagnose because cultures are often negative.

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Anjum Dhamani

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Author List Amna Naveed Butt, Anjum Dhamani, Haily Garza, Kanza Maqsood, Kishan Talagadadeevi, Nishath Naseem, Obulakshmipriya Subramanian, Yash Bhavsar

Category Clinical Vignettes

Concept Blastomycosis

Concept Central Nervous System Involvement

Concept Meningoencephalomyelitis

Concept Liposomal Amphotericin B

Concept Azole Therapy

Distinguished Non-Finalist

Presenter Organization Texas Health Resources

Presenting Author Anjum Dhamani

Track Adult

Keywords

blastomycosis

central nervous system infection

neurosarcoidosis mimic

fungal meningitis

Texas

sweat lodge exposure

lymphocytic pleocytosis

leptomeningeal enhancement

liposomal amphotericin B

environmental exposure

Blastomycosis

Central Nervous System Involvement

Meningoencephalomyelitis

Liposomal Amphotericin B

Azole Therapy