Coccidioidal meningitis complicated by cerebral arteritis and infarction

Carvalho, Carlos Alberto de; Allen, J. Norman; Zafranis, Aristidis; Yates, Allen J.

doi:10.1016/s0046-8177(80)80013-x

Cited by 29 publications

(5 citation statements)

References 4 publications

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“…Spread of Mycobacterium tuberculosis to the aorta may be seen as a cause of tuberculous aortitis, coronary arteritis, and mycotic aneurysm [74][75][76]. Aspergillus aeruginosa, Aspergillus fumigatus, and Mucor may be characterized by direct vessel invasion and necrosis [59,77,78] Coccidioides immitis meningitis may be associated with vasculitis that can be confused with central nervous system Angeitis [79,80]. Coccidioides immitis may also present as an immune-complex-mediated disease with erythema nodosum, periarthritis predominantly of the ankles, and bihilar lymphadenopathy [81,82].…”

Section: Bacterial Causes Of Vasculitismentioning

confidence: 99%

Infectious Causes of Vasculitis

Choucair¹

2013

Updates in the Diagnosis and Treatment of Vasculitis

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Section: Bacterial Causes Of Vasculitismentioning

confidence: 99%

Infectious Causes of Vasculitis

Choucair¹

2013

Updates in the Diagnosis and Treatment of Vasculitis

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“…Patients have been documented to acutely infarct without warning months to even years after the initial diagnosis has been made. 8,9 Infarction has been cited to occur in approximately 15% to 20% of confirmed cases of infection with C immitis. 4 Aggressive treatment regimens for this severe form of meningitis are crucial and must be implemented immediately on initial suspicion.…”

Section: Discussionmentioning

confidence: 99%

Visual Changes in a 4-Year-Old

Stanga

Dajud

2008

Clin Pediatr (Phila)

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blood cells and 2 red blood cells. Differential showed 14% neutrophils, 55% lymphocytes, 9% monocytes, and 18% eosinophils. The cerebrospinal fluid (CSF) glucose was 53, protein was 43.2, and Gram stain was negative for microorganisms. Blood culture was negative. Chest X ray and KUB (kidney, ureter, bladder) were normal. CT performed at the outlying regional medical center was negative for any acute intracranial process. HSV PCR (herpes simplex virus polymerase chain reaction) along with spinal fluid cultures were obtained and sent.The patient was initially started on intravenous (IV) ceftriaxone for bacterial coverage and acyclovir for possible herpetic meningoencephalitis. On the second day of admission, the patient experienced several simultaneous tonic/clonic seizures that resolved with IV phenytoin. MRI of the brain revealed a small area of infarction within the leftbasal ganglia and the right superior cerebellar hemisphere. The patient was started on oxycarbazepine for seizure prophylaxis. Immunoglobulin and complement titers were sent. On day 3 of admission, the patient awoke with severe lethargy, bilateral lowerextremity spasticity, right-eye ptosis, horizontal nystagmus, and gross left-sided hemiplegia. A repeat MRI demonstrated very large infarcts in the leftand right-basal ganglia and the right-temporal lobe not previously visualized. Blood cultures revealed no growth, and HSV PCR was found to be negative on the third day. Immunoglobulin titers revealed an immunoglobulin E of 9147 (normal, 0-230 U/mL). Immunoglobulins A, G, M, and complement C3, C4 were within normal limits. Out of concern for a fungal infectious etiology, the patient was immediately transferred to a tertiary intensive care unit for infectious disease consult. She was started on IV voriconazole. Further workup and repeat lumbar puncture demonstrated CSF that grew Coccidioides immitis, and antifungal therapy was switched to amphotericin B. The patient recovered well after a prolonged hospital stay and suffered minimal deficits Case ReportA 4-year-old female child was admitted on transfer from a regional medical center for symptoms of nausea, vomiting, dehydration, and complaints of headache and visual changes for approximately 4 days. Her symptoms had progressively worsened over time, and the patient was admitted for suspected meningitis. Past medical history was significant for recurrent upper respiratory infections as well as sinus and skin infections most notably eczema herpeticum. Previous metabolic and immunological workup for her symptoms was significant only for an elevated immunoglobulin E of 805 U/mL (normal 0-230 U/mL), and no definitive diagnosis was established at that time.Physical examination on admission revealed a well-developed, well-nourished female child within the 50th percentile of weight and 3rd percentile of height. Her temperature was 37.1°C; heart rate, 94 beats/min; respiratory rate, 18/min; and blood pressure, 116/76 mm Hg. The patient complained of photophobia on exam but denied any true nuchal rigidity, and ...

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“…Vasculitis was recognized early as a pathological event in CNS coccidioidomycosis [8] but was not well described as a clinical entity until later [76,77]. Williams et al reported 10 cases in 1992.…”

Section: Complicationsmentioning

confidence: 99%

Central Nervous System Infections Due to Coccidioidomycosis

Jackson

Blair

Ampel

2019

JoF

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Coccidioidomycosis is a common infection in the western and southwestern United States as well as parts of Mexico and Central and South America and is due to the soil-dwelling fungi Coccidioides. Central nervous system (CNS) infection is an uncommon manifestation that is nearly always fatal if untreated. The presentation is subtle, commonly with headache and decreased mentation. The diagnosis should be considered in patients with these symptoms in association with a positive serum coccidioidal antibody test. The diagnosis can only be established by analysis of cerebrospinal fluid (CSF), which typically demonstrates a lymphocytic pleocytosis, hypoglycorrhachia, elevated protein, and positive CSF coccidioidal antibody. Cultures are infrequently positive but a proprietary coccidioidal antigen test has reasonable sensitivity. Current therapy usually begins with fluconazole at 800 mg daily but other triazole antifungals also have efficacy and are often used if fluconazole fails. Triazole therapy should be lifelong. Intrathecal amphotericin B, the original treatment, is now reserved for those in whom triazoles have failed. There are several distinct complications of CNS coccidioidal infection, the most common of which is hydrocephalus. This is nearly always communicating and requires mechanical shunting in addition to antifungal therapy. Other complications include cerebral vasculitis, brain abscess, and arachnoiditis. Management of these is difficult and not well established.

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Coccidioidal meningitis complicated by cerebral arteritis and infarction

Cited by 29 publications

References 4 publications

Infectious Causes of Vasculitis

Infectious Causes of Vasculitis

Visual Changes in a 4-Year-Old

Central Nervous System Infections Due to Coccidioidomycosis

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