SHM Converge Scientific Abstract ePoster Gallery-Fungal Meningitis Outbreak Following Epidural Anesthesia in Immunocompetent Patients: A Public Health Concern

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This case report describes a 27-year-old immunocompetent woman who developed subacute fungal meningitis about two months after cosmetic surgery in Matamoros, Mexico. She presented with headache, neck stiffness, fever, nausea, vomiting, photophobia, and back pain. Initial evaluation showed elevated inflammatory markers, meningeal signs, and MRI spine findings of leptomeningeal enhancement. Early CSF studies showed pleocytosis, mildly low glucose, and elevated protein, but routine cultures and viral, cryptococcal, and coccidioidal testing were negative, so she was initially treated for presumed bacterial meningitis.<br /><br />Her course became more concerning after repeated lumbar punctures showed worsening CSF inflammation. A positive serum beta-D-glucan later raised suspicion for fungal meningitis, and in the context of a CDC alert about an outbreak linked to contaminated epidural procedures, she was started on antifungal therapy with voriconazole and amphotericin B. Because systemic treatment alone was insufficient and her CSF parameters did not improve, a ventricular access device was placed for intrathecal amphotericin B delivery.<br /><br />She gradually improved and was discharged on oral voriconazole plus intrathecal amphotericin B, with subsequent lumbar puncture showing improvement and full recovery reported at follow-up.<br /><br />The case occurred during an ongoing outbreak of nosocomial fungal meningitis associated with procedures in Matamoros, with Fusarium solani confirmed in multiple cases. The report emphasizes that fungal meningitis can occur even in immunocompetent patients, is difficult to diagnose early, and requires rapid public health coordination. It also highlights the limitations and toxicity of antifungal therapy and suggests intrathecal amphotericin B may be a useful option in severe refractory cases.

Asset Subtitle

Waleed Ikram

Meta Tag

Author List Osama Qasim Agha, SAI-SRIDHAR Boddupalli, Tatyana Shekhel, Waleed Ikram

Category Clinical Vignettes

Concept Fungal Meningitis

Concept Fusarium solani

Concept Amphotericin B

Concept Immunocompetent Patient

Concept Clinical Presentation

Distinguished Non-Finalist

Presenter Organization Creighton University - Phoenix

Presenting Author Waleed Ikram

Track Adult

Keywords

fungal meningitis

immunocompetent woman

cosmetic surgery

Matamoros Mexico

Fusarium solani

beta-D-glucan

intrathecal amphotericin B

voriconazole

nosocomial outbreak

cerebrospinal fluid

Fungal Meningitis

Fusarium solani

Amphotericin B

Immunocompetent Patient

Clinical Presentation