Coccidioidal meningitis diagnosed by skin biopsy

Area of Science:

• Infectious Diseases
• Neurology
• Dermatology

Background:

• Coccidioidomycosis is a fungal infection endemic to specific regions, often presenting with pulmonary or disseminated disease.
• Meningitis is a serious inflammation of the membranes surrounding the brain and spinal cord.
• Diagnosis of coccidioidal meningitis can be challenging, especially in non-endemic areas, leading to delayed treatment.

Observation:

• A patient presented with meningitis symptoms, initially suspected to be tuberculosis or sarcoidosis due to residing outside endemic zones.
• A verrucous skin lesion on the patient's face was biopsied for diagnostic purposes.
• The skin biopsy was crucial in confirming the diagnosis of coccidioidomycosis.

Findings:

• Skin biopsy confirmed coccidioidal meningitis, resolving diagnostic uncertainty.
• The patient received consolidation therapy including intrathecal amphotericin B and oral ketoconazole.
• The patient showed a positive response to the targeted antifungal treatment.

Implications:

• Highlights the importance of considering coccidioidomycosis even in non-endemic regions when clinical suspicion is high.
• Demonstrates the diagnostic value of skin biopsies in cases of suspected disseminated fungal infections.
• Emphasizes the effectiveness of combined intrathecal and oral antifungal therapy for coccidioidal meningitis.