A Case of Coccidioides Meningitis in an Immunocompetent Host and the Challenges in Diagnosis

Coccidioides is the causative organism for Coccidioidomycosis or otherwise known as "Valley fever." Valley fever usually presents as upper respiratory tract illness which can often be complicated by dissemination. Although immunosuppression increases the risk of disseminated disease, it can also be seen in immunocompetent patients. Coccidioides meningitis is the most feared outcome of disseminated coccidioides infection, rendering early diagnosis and treatment imperative. However, the diagnosis of coccidioides meningitis is challenging due to its vague presentation and its resemblance to other CNS disorders, both infectious and noninfectious. Moreover, serum and cerebrospinal fluid serologies, which are the mainstay in diagnosing coccidioides meningitis, can be inconclusive during the early phases of the disease process, potentially leading to missed diagnosis. Therefore, keeping a very high index of suspicion for coccidioides meningitis is crucial. Initiating antifungals early in suspected coccidioides meningitis even with inconclusive serologies may be appropriate as well. We present a case of coccidioides meningitis in an immunocompetent patient and the associated diagnostic challenges to guide physicians with the diagnosis and prevent fearsome complications.