SHM Converge Scientific Abstract ePoster Gallery-Coccidioides Meningitis in a Previously Healthy Immunocompetent Individual

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This document describes a rare case of disseminated coccidioidomycosis (“Valley Fever”) progressing to coccidioidal meningitis in a previously healthy 21-year-old man. Although coccidioidomycosis is usually a self-limited respiratory infection endemic to the U.S. Southwest, it can disseminate to the central nervous system and cause severe, life-threatening disease even in immunocompetent patients.<br /><br />The patient had recently returned from training in the California desert and initially presented with cough and chest pain. Imaging showed a cavitary right upper-lobe lesion, and bronchoalveolar lavage confirmed Coccidioides immitis. He improved on fluconazole, but months later developed fever, severe headaches, and photophobia. Multiple lumbar punctures and CSF PCR/cultures were negative, but serologic testing supported meningitis, with CSF complement fixation titer of 1:16. This highlights that CSF cultures may be negative and diagnosis may depend on serology, imaging, and exposure history.<br /><br />Despite antifungal therapy, he worsened with elevated intracranial pressure requiring serial lumbar punctures and ventriculoperitoneal shunt placement. He was later found to have superior sagittal sinus thrombosis, then progressive meningeal and spinal disease, including cervical cord expansion and suspected subarachnoid abscess. Treatment was complicated by liver toxicity from azoles: fluconazole was intensified, then voriconazole and posaconazole were tried but discontinued because of transaminase elevation. Ultimately, intravenous amphotericin B was started until liver function improved, after which he was transitioned to lifelong posaconazole.<br /><br />The report emphasizes that coccidioidomycosis should remain in the differential for pulmonary and neurologic symptoms in patients with exposure to endemic areas, even without classic risk factors. Early recognition, multidisciplinary management, and prolonged antifungal therapy are crucial to preventing severe outcomes.

Asset Subtitle

Christian Pena

Meta Tag

Author List Aymen Baig, Carolina Velez-Mejia, Christian Pena, Nathaniel Gill

Category Clinical Vignettes

Concept Coccidioidomycosis

Concept Coccidioidal Meningitis

Concept Disseminated infection

Concept Complement Fixation Titer

Concept Azole Antifungal

Distinguished Non-Finalist

Presenter Organization UTHSCSA - UT Health Science Center at San Antonio

Presenting Author Christian Pena

Track Adult

Keywords

coccidioidomycosis

Valley Fever

coccidioidal meningitis

Coccidioides immitis

central nervous system

intracranial pressure

ventriculoperitoneal shunt

superior sagittal sinus thrombosis

antifungal therapy

endemic exposure

Coccidioidomycosis

Coccidioidal Meningitis

Disseminated infection

Complement Fixation Titer

Azole Antifungal