Coccidioides immitis presenting as a hyphal form in a ventriculoperitoneal shunt

We report a case of meningitis in a 31-year-old man caused by Coccidioides immitis, where the organism was observed growing in the cerebrospinal fluid exclusively as hyphae. This unusual morphology was seen in fluid obtained from a ventriculoperitoneal shunt. Only C immitis was cultured. Its identity was confirmed by both DNA probes and standard culture techniques. To our knowledge this is the second report of C immitis taking a hyphal form in cerebrospinal fluid. Coccidioides immitis should be considered in the differential diagnosis when hyphal forms are seen in body fluids. The diagnosis can be hastened by using DNA probes, which enhance patient therapy and worker safety.