Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 14, Number 3, March 2023, pages 81-87

A Rare Case of Coccidioidomycosis Meningitis


Figure 1.
Figure 1. Computed tomography (CT) scan of the head with intravenous (IV) contrast, showing focal hemorrhage versus enhancing mass (blue arrow) involving the genu of the corpus callosum measuring 1.1 × 1.8 × 3.9 cm.
Figure 2.
Figure 2. Magnetic resonance imaging (MRI) of the brain without intravenous (IV) contrast, showing large hemorrhagic mass extending across the splenium of the corpus callosum measuring 4.7 cm (red arrow) with surrounding edema.


Table 1. Significant Laboratory Results From the Cerebrospinal Fluid
Spinal fluidPatient value (units)Reference range
µL: microliter, dL: deciliter, mg: milligram, RBCs: red blood cells; WBCs: white blood cells; CSF: cerebrospinal fluid.
Glucose, CSF81 mg/dL40 - 70 mg/dL
Protein, CSF146 mg/dL15 - 45 md/dL
RBC, CSF10,000 µL0 µL
WBC, CSF4 µL0 µL
Coccidioides, CSF1:1< 1:1
Opening pressure, CSF43 mL


Table 2. Demographic Details, Diagnostic Information, Human Immunodeficiency Virus Status, and Outcomes for Patients Diagnosed With Coccidioidomycosis Meningitis (Review of Literature)
ReferenceAgeSexGeographic locationHIV statusComorbid conditionsInitial presentationPlasma titerCSF titerTreatmentsOutcome
F: female; M: male; LA: Los Angeles; CA: California; USA: United States of America; CSF: cerebrospinal fluid; GA: Georgia; N/a: not available; IV: intravenous; PO: oral QD: daily; BID: twice daily; TID: three times a day; LAmB: liposomal amphotericin.
[7]49FLA, CA, USANegativeNoneHeadaches, fevers, vomiting, and maculopapular rashes (1.5 × 1.5 cm) on the face and backN/aN/aIV fluconazole (800 mg intravenously daily), IV ceftriaxone (4 g q24h), and IV mannitol (125 mL intravenously q8h).Recovered
[8]66MN/aNegativeNoneFacial pain, fever1:1281:32PO fluconazole 400 mg daily. IV liposomal amphotericin, high-dose fluconazole, intrathecal (IT) amphotericin B and voriconazole. IV isavuconazole (372 mg every 8 h for six doses, then every 24 h thereafter) (35-day therapy).Recovered
[8]33FN/aNegativeNoneFound downN/a1:8Intravenous high-dose fluconazole 400 mg twice daily. High-dose fluconazole, IV LAmB and concomitant IT amphotericin B. IV isavuconazole (372 mg every 8 h for six doses, then every 24 h thereafter) (23-day therapy).Comatose
[8]22MN/aNegativeNone3 months of headachesN/a1:8PO posaconazole 300 - 600 mg QD (34-day therapy). PO voriconazole 300 mg BID (17-day therapy). PO fluconazole 600 mg BID (11-day therapy). IV voriconazole 300 mg BID (13-day therapy). PO itraconazole suspension 200 mg TID (204-day therapy). PO isavuconazole 372 mg QD (55-day therapy). PO fluconazole 600 mg BID, IV amphotericin B 5 - 10 mg/kg QD, IT amphotericin B (295-day therapy).Recovered
[9]36MCentral Valley, CA, USANegativeNoneHeadache, nausea, vomiting1:2561:8PO 1,200 mg daily fluconazole and IV liposomal amphotericin-B 5 mg/kg QD, followed by a PO dexamethasone for 15 days and PO fluconazole 800 mg daily. IV liposomal amphotericin-B 5 mg/kg QD and PO voriconazole 400 mg BID, IV dexamethasone 3 mg IV every 6 h, with a 5-day taper to 1 mg IV every 12 h, IV posaconazole 300 mg QD.Expired
[10]42MHobbs, New Mexico, USANegativeNone3-week history of headache, malaise, low-grade fevers, photophobia, phonophobia, and vomitingN/aN/aIV acyclovir 900 mg every 8 h, IV vancomycin 2 g every 8 h, IV ceftriaxone 2 gram every 12 hours, and IV dexamethasone 10 mg × 1 dose. PO isoniazid 3 mg daily, PO rifampin 100 mg daily, PO ethambutol 1,600 mg daily, PO pyrazinamide 2,000 mg daily, IV dexamethasone 8 mg every 8 h, IV LAmB 200 mg daily. PO fluconazole 800 mg daily, dexamethasone taper.Recovered
[11]26MSouthwest, USANegativeNonePersistent fevers, headache, nausea, and vomitingHighN/aIV fluconazole 1,200 mg daily. IV LAmB 10 mg/kg daily, dexamethasone. fluconazole was replaced with IV voriconazole with loading dose of 6 mg/kg IV BID for two doses; then maintenance dose of 4 mg/kg IV BID. Lifelong triazole therapy.Recovered
[12]53MN/aNegativeCoccidioidal meningitis diagnosed 3 years priorNew onset diplopia secondary to a right-sided CN VI palsy that followed 2 weeks of progressively severe worsening headaches1:161:4PO fluconazole 800 mg daily. IV LAmB 5 mg/kg/day × 14 days, then transitioned to PO voriconazole 200 mg QD.Recovered
[12]27MN/aNegative5-year history of coccidioidal meningitisSevere headache, meningismus, and normal mentationN/a1:45-year history of PO fluconazole 1,000 mg QD. IV LAmB 5 mg/kg/day × 14 days, then transitioned to PO voriconazole 200 mg QD.Recovered
[13]39MCentral Valley, CA, USANegative21 years of heavy alcohol useWeight loss, night sweatsNegativePositivePO fluconazole 400 mg daily.Recovered
[14]53FN/aNegativeCoccidioidal meningitisGait instability, confusion, and headacheN/aN/aIV fluconazole, then switched to PO fluconazole.Recovered
[15]55MMexicoNegativeNoneBilateral upper extremities weakness1:128PositiveHigh-dose steroids, IV LAmB.Expired
[16]30FSan Joaquin Valley, CA, USANegative14 weeks’ gestationHeadaches, nausea, vomiting, joint pain, fevers, circular erythematous lesions on her right thumb and backN/aN/aintravenous LAmB, intrathecal amphotericin B, and intrathecal hydrocortisone.Recovered
[17]59MAtlanta, GA, USAPositiveHIV, epididymitisHeadache, photophobia, neck stiffness, fevers, chills, weight loss, dyspnea, cough, scant hemoptysisN/aN/aFour-drug therapy (PO isoniazid daily, PO rifampin daily, PO ethambutol daily, PO pyrazinamide daily) and dexamethasone for tuberculous meningitis.Expired