SHM Converge Scientific Abstract ePoster Gallery-Progressive Encephalopathy: A Case of the Rare and Difficult to Diagnose Candida Meningitis

Pdf Summary

This case describes a 41-year-old man with alcohol and opioid use disorder, traumatic brain injury, and schizoaffective disorder who developed progressive confusion, agitation, and worsening hydrocephalus over several months. Early imaging showed communicating hydrocephalus and basilar leptomeningeal enhancement, but repeated evaluations attributed his symptoms to psychiatric illness, substance use, or prior brain injury. He was briefly treated empirically for meningitis and improved, yet infectious and autoimmune testing was negative, and no definitive diagnosis was made.<br /><br />Over the following months, his encephalopathy worsened. On his final presentation, he deteriorated to the point of requiring intubation, with signs of herniation and a blown pupil. Imaging showed severe hydrocephalus and worsening leptomeningeal enhancement, prompting external ventricular drain placement. Cerebrospinal fluid studies later revealed markedly abnormal findings: very low glucose, extremely high protein, pleocytosis, elevated beta-D-glucan, and fungal culture growth of Candida albicans. A biopsy and CSF fungal testing helped confirm the diagnosis of chronic Candida meningitis.<br /><br />He was treated with amphotericin B plus flucytosine, and his drain was later exchanged for a ventriculoperitoneal shunt. His course remained complicated by persistent hydrocephalus and abscess formation, requiring prolonged antifungal therapy and hospitalization.<br /><br />The key teaching points are that chronic Candida meningitis can present subtly with progressive encephalopathy rather than classic meningitis symptoms, and it can occur even without neurosurgical instrumentation. Diagnosis may require large-volume CSF sampling and supportive non-culture tests such as beta-D-glucan, low glucose, high protein, and pleocytosis. Candida meningitis carries high mortality, making early recognition and treatment critical.

Asset Subtitle

Jaclyn Vargas

Meta Tag

Author List Jaclyn Vargas, Kevin Dinh

Category Clinical Vignettes

Concept Candida Meningitis

Concept CSF Fungal Culture

Concept Amphotericin B

Concept Flucytosine

Concept Encephalopathy

Distinguished Non-Finalist

Presenter Organization Ucsf

Presenting Author Jaclyn Vargas

Track Adult

Keywords

Candida meningitis

chronic meningitis

hydrocephalus

leptomeningeal enhancement

encephalopathy

beta-D-glucan

cerebrospinal fluid

fungal culture

amphotericin B

ventriculoperitoneal shunt

Candida Meningitis

CSF Fungal Culture

Amphotericin B

Flucytosine

Encephalopathy