Dados do Trabalho

Título

INTRACRANIAL AND SPINE LEPTOMENINGEAL, RADICULAR AND PULMONARY COCCIDIOIDOMYCOSIS IN IMMUNOCOMPETENT PATIENT

Descrição sucinta do(s) objetivo(s)

To present a case report of an unusual fungal infection, especially in immunocompetent patients.

História clínica

A 17-year-old male presented at the Emergency Department with a fever and headache with a worsening of his mental state after a few days. He was living in the Western US for 10 months. The imaging investigation revealed intracranial and spine leptomeningeal enhancement with cranial and radicular nerves, and intracranial arteries involvement, in addition to ventriculitis, hydrocephalus, and basal ganglia infarction. The lung images revealed a cavitary lesion. The CSF analysis showed high protein and cellularity. The PCR for Mycobacterium tuberculosis was negative in CSF and the fungal CSF culture revealed Coccidioides immitis. Investigation for HIV and primary immunodeficiency were all negative.

Discussão e diagnóstico

The final diagnosis was intracranial leptomeningeal, radicular, and pulmonary coccidioidomycosis. This condition is endemic to arid regions of the Western Hemisphere and the most common clinical presentation is an asymptomatic acute infection or mild flu-like symptoms in some patients. The CNS involvement with meningitis is one of the most serious clinical manifestations, a form of disseminated infection. The patient received adequate treatment but maintained a headache. The follow-up exams revealed worsening of hydrocephalus and the patient went over ventriculoperitoneal shunt.

Conclusões

This challenging case illustrates the important role of image exams in the infection scenario to discard hydrocephalus and signs of intracranial hypertension initially on CT, and also to detect signs of complications on MRI. Familiarity of the Radiologist with this particular scenario impact on clinical outcomes.

Palavras Chave

Coccidioidomycosis; Central nervous system; Meningitis

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