Coccidioidal meningitis complicated by cerebral arteritis and infarction

Area of Science:

• Neurology
• Infectious Diseases
• Pathology

Background:

• Coccidioidomycosis is a fungal infection endemic to the southwestern United States.
• Disseminated coccidioidomycosis can affect various organs, including the central nervous system.
• Cerebral arteritis is an uncommon complication of Coccidioides immitis infection.

Observation:

• A patient in a nonendemic region presented with symptoms suggestive of meningitis.
• Clinical diagnosis was challenging due to atypical neurological deficits and hydrocephalus.
• Autopsy confirmed chronic basal meningitis and cerebral arteritis caused by Coccidioides immitis.

Findings:

• The autopsy revealed extensive pathology including cerebral infarcts and hydrocephalus secondary to meningitis.
• An old solitary pulmonary granuloma indicated a prior, possibly subclinical, Coccidioides immitis infection.
• Cerebral arteritis, a rare manifestation, was a key finding in this case.

Implications:

• This case underscores the importance of considering coccidioidal meningitis in patients with unexplained neurological symptoms, even outside endemic areas.
• The clinicopathological correlation highlights the severe neurological sequelae of Coccidioides immitis infection.
• Increased awareness and diagnostic vigilance are crucial for managing this rare but serious fungal infection.