Disseminated Coccidioidomycosis: Cutaneous, Soft Tissue, Osseous, and “Shotgun Intraparenchymal” Brain Disease

Abstract

Coccidioidomycosis is a disease found in the southwestern United States and caused by inhalation of arthroconidia of Coccidioides immitis and posadasii. Although the disease is most commonly asymptomatic or respiratory, it has a propensity to disseminate to any tissue in the body with the most common being skin, bone, joints, and central nervous system. This case demonstrates the dissemination of coccidioidomycosis to several foci along with a rare form of parenchymal dissemination with an unusual neuroradiological finding.

Non-shunt Management of Communicating Hydrocephalus in an Immunocompetent Host With Disseminated Central Nervous System Coccidioidomycosis

“…Over the last 25 years, there has been an increased incidence of disseminated coccidioidomycosis of varying manifestations in hosts without known immunocompromise, from tenosynovitis to meningitis with resultant hydrocephalus. 1 - 4 Presenting symptoms of coccidioidomycosis meningitis include progressively worsening headaches, nausea, vomiting, visual deficits, and mental status changes with fewer traditional meningeal signs like nuchal rigidity. 5 , 6 In addition to antifungal therapy, standard of care for coccidioidomycosis meningitis with symptomatic hydrocephalus includes neurosurgical intervention for definitive management of increased intracranial pressure (ICP).…”