1606. Three Cases of Brain Intraparenchymal Coccidioidomycosis
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Epidemiology
Friday, October 28, 2016
Room: Poster Hall
Posters
  • IDSA (1).pdf (795.2 kB)
  • Background: Intraparenchymal Coccidioidomycosis (Cocci) is a rare form of disseminated Central Nervous System (CNS) infection.

    Methods: 153 cases of CNS Cocci between 1987-2014 at Kern Medical Center reviewed. Three cases of intraparnchymal were found.

    Results:

    Case 1: 57 year old male with pulmonary Cocci with dissemination to CNS with meningitis and spinal arachnoiditis. He failed fluconazole and was placed on voriconazole. He developed encephalitis and MRI brain showed nodule in the deep posterior right frontal lobe with surrounding edema plus asymmetric enhancement of the meninges of the left middle cranial fossa and left aspect of the tentorium as well as adjacent temporal lobe. (Image Case 1: MRI brain post contrast). He was placed on prolonged course of intravenous liposomal amphotericin with near resolution of symptoms and neuroimaging abnormalities.

    Case 2: 27 year old male with acquired immunodeficiency syndrome with pulmonary Cocci who failed fluconazole. He was found to have dissemination to soft tissue, osseous, lymph nodes and vocal cords. He was placed on intravenous liposomal amphotericin and tapered to oral posaconazole. Later he developed sudden onset diplopia. His brain MRI showed new enhancing lesion at right upper paramesencephalic and suprasellar cistern. (Image Case 2: MRI brain post contrast). His lumbar spinal fluid confirmed meningitis. He was started on intrathecal amphotericin via ommaya reservoir with near resolution of symptoms and neuroimaging abnormalities.

    Case 3: 36 year old male with cavitary and miliary pulmonary Cocci. He was found to have dissemination to cutaneous, osseous and lymph nodes. Later he developed encephalitis and seizure. His brain MRI showed multiple enhancing lesions at cerebellum, both occipital lobes, inferior right frontal lobe, left lateral geniculate body and the left cerebellar in addition to an abnormal signal extending along the left optic tract toward the lateral geniculate body extending into the white matter of the posterior temporal lobe.  (Image Case 3: MRI brain post contrast). He was placed on high dose fluconazole with improvement of his symptoms.

    Conclusion:

    Incident of intraparanchymal Coccidioidomycosis is low. The diagnosis should be considered in cases with encephalitis or presence of focal neurological symptoms. There is no definitive treatment.

     

    Arash Heidari, M.D.1, Samiollah Gholam, M.D.2 and Royce H. Johnson, M.D., F.A.C.P., FIDSA1, (1)Infectious Diseases, Kern Medical Center/UCLA, Bakersfield, CA, (2)Internal Medicine, Kern Medical/UCLA, Bakersfield, CA

    Disclosures:

    A. Heidari, None

    S. Gholam, None

    R. H. Johnson, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.