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Marked polymorphonuclear pleocytosis due to blastomycotic meningitis: case report and review
W B Harley1, M Lomis, D W Haas
1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232.
Abstract:
Meningitis is an unusual manifestation of infection caused by Blastomyces dermatitidis. We describe a patient who presented with fulminant blastomycotic meningitis. Examination of the lumbar CSF demonstrated > 5,000 polymorphonuclear leukocytes/mm3. The diagnosis of B. dermatitidis meningitis was initially suggested by cytologic examination of CSF and confirmed by culture. Pleocytosis of this magnitude had not been previously described in association with blastomycosis, although review of the published literature revealed that neutrophilic pleocytosis is a common manifestation of blastomycotic meningitis and should suggest the diagnosis. This report broadens the clinical spectrum of blastomycotic meningitis and suggests that cytologic examination of CSF is a useful way to establish this diagnosis.
Insights
Blastomyces dermatitidis can cause meningitis, a rare but serious infection. This case highlights that high white blood cell counts in cerebrospinal fluid (CSF) can indicate blastomycotic meningitis, aiding diagnosis.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Neurology
Background:
- Meningitis is inflammation of the membranes surrounding the brain and spinal cord.
- Blastomyces dermatitidis is a fungus endemic to North America, typically causing pulmonary infections.
- Meningitis is an uncommon presentation of Blastomyces dermatitidis infection.
Observation:
- A patient presented with severe, rapidly progressing blastomycotic meningitis.
- Cerebrospinal fluid (CSF) analysis revealed a significant polymorphonuclear leukocyte count (> 5,000/mm3).
- This level of pleocytosis was previously undescribed in blastomycosis.
Findings:
- Cytologic examination of CSF initially suggested Blastomyces dermatitidis meningitis.
- Cerebrospinal fluid (CSF) culture confirmed the diagnosis.
- Neutrophilic pleocytosis is a common finding in blastomycotic meningitis and a valuable diagnostic clue.
Implications:
- This case expands the known clinical spectrum of blastomycotic meningitis.
- Cytologic analysis of CSF is a useful diagnostic tool for identifying Blastomyces meningitis.
- Early diagnosis and treatment are crucial for managing this rare but severe fungal infection.