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A Case of Coccidioidal Meningitis
Jung Woo Lee, Sang Il Kim, Youn Jeong Kim, Jae-Cheol Kwon, Ye Jee Lim, Mi Hee Park, Seon A Kim, Eun Sil Koh, Min Ju Kim, and Moon Won Kang
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
Vol.44 Num.2 (p75~79)
A 35-year-old man with known coccidioidal meningitis developed a severe headache and vomiting during routine treatment. Hydrocephalus was visible on brain imaging, and CSF study revealed pleocytosis, lowering of glucose, and increased intracranial pres¬sure. Dexamethasone and mannitol was used for intracranial pressure control. In¬trathecal amphotericin B administration and switching to itraconazole resulted in gradual improvement of symptoms. After 4 months of discontinuing amphotericin B intrathecal administration, the patient developed severe headaches with vomiting, diplopia and tandem gait. Coccidioidal meningitis aggravation was suspected based on brain MRI and CSF studies. Ventriculo-peritoneal shunt insertion was per¬formed for intracranial pressure control and the combined therapy of intrathecal amphotericin B administration and fluconazole was maintained. This combined regimen kept the meningitis stable for 1 month.
Keywords : Coccidioidomycosis, Meningitis, Intrathecal, Amphotericin B