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Coccidioidomycosis meningitis with massive dural and cerebral venous thrombosis and tissue arthroconidia
B K Kleinschmidt-DeMasters1, M Mazowiecki, L A Bonds
1Department of Pathology, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
Abstract:
To our knowledge we report the first case of meningitis from Coccidioides immitis associated with massive dural and cerebral venous thrombosis and with mycelial forms of the organism in brain tissue. The patient was a 43-year-old man with late-stage acquired immunodeficiency syndrome (AIDS) whose premortem and postmortem cultures confirmed C immitis as the only central nervous system pathogenic organism. Death was attributable to multiple hemorrhagic venous infarctions with cerebral edema and herniation. Although phlebitis has been noted parenthetically to occur in C immitis meningitis in the past, it has been overshadowed by the arteritic complications of the disease. This patient's severe C immitis ventriculitis with adjacent venulitis appeared to be the cause of the widespread venous thrombosis. AIDS-related coagulation defects may have contributed to his thrombotic tendency.
Insights
This study details a rare case of Coccidioides immitis meningitis in an AIDS patient, complicated by extensive cerebral venous thrombosis. The fungal infection likely caused severe inflammation leading to fatal brain swelling.
Area of Science:
- Infectious Diseases
- Neurology
- Mycology
Background:
- Coccidioides immitis is a fungus endemic to the southwestern United States, known to cause coccidioidomycosis.
- Meningitis is a serious infection of the membranes surrounding the brain and spinal cord.
- Acquired immunodeficiency syndrome (AIDS) compromises the immune system, increasing susceptibility to opportunistic infections.
Observation:
- A 43-year-old male with late-stage AIDS presented with symptoms suggestive of central nervous system infection.
- Cultures confirmed Coccidioides immitis as the sole pathogen in the central nervous system.
- The patient exhibited massive dural and cerebral venous thrombosis, a rare complication.
Findings:
- The case represents the first documented instance of Coccidioides immitis meningitis associated with extensive cerebral venous thrombosis and the presence of mycelial forms in brain tissue.
- Severe ventriculitis and venulitis caused by Coccidioides immitis were identified as the likely drivers of the widespread venous thrombosis.
- Hemorrhagic venous infarctions, cerebral edema, and herniation were the direct causes of death.
Implications:
- This case highlights the potential for Coccidioides immitis to cause severe vascular complications beyond typical arteritis in immunocompromised individuals.
- It underscores the importance of considering fungal meningitis in AIDS patients with neurological symptoms and thrombotic events.
- Further research may be warranted to explore the interplay between fungal infections, venous thrombosis, and coagulation defects in AIDS patients.