Aseptic Meningitis Unmasking Coccidioidomycosis of the Central Nervous System Outside an Endemic Region
Abstract
A 20-year-old male presented with persistent aseptic meningitis. Cerebrospinal fluid (CSF) showed neutrophil-dominant pleocytosis, high protein, low glucose, and an opening pressure >55 cmH2O. Fluid metagenomic next-generation sequencing detected Coccidioides immitis/posadasii and subsequent culture confirmed the diagnosis. The retrospective history revealed residence in Arizona approximately six months prior to hospitalization. Antifungal therapy was escalated, and the patient was transferred to a tertiary neurocritical care center for advanced neurocritical care. This case demonstrates that geographic bias can delay the recognition of coccidioidal meningitis outside endemic regions. Clinicians should therefore obtain a patient’s travel history even if the patients have only a remote travel history.
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BibTeX
@article{kondo2026aseptic,
title = {{Aseptic Meningitis Unmasking Coccidioidomycosis of the Central Nervous System Outside an Endemic Region}},
author = {Shunsuke Kondo and Neha Kumar and Natsumi Hamahata},
journal = {Internal Medicine},
year = {2026},
month = sep,
doi = {10.2169/internalmedicine.7538-26},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7538-26/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Aseptic Meningitis Unmasking Coccidioidomycosis of the Central Nervous System Outside an Endemic Region
AU - Shunsuke Kondo
AU - Neha Kumar
AU - Natsumi Hamahata
PY - 2026
DA - 2026/09/29
JO - Internal Medicine
DO - 10.2169/internalmedicine.7538-26
UR - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7538-26/_article
AB - A 20-year-old male presented with persistent aseptic meningitis. Cerebrospinal fluid (CSF) showed neutrophil-dominant pleocytosis, high protein, low glucose, and an opening pressure >55 cmH2O. Fluid metagenomic next-generation sequencing detected Coccidioides immitis/posadasii and subsequent culture confirmed the diagnosis. The retrospective history revealed residence in Arizona approximately six months prior to hospitalization. Antifungal therapy was escalated, and the patient was transferred to a tertiary neurocritical care center for advanced neurocritical care. This case demonstrates that geographic bias can delay the recognition of coccidioidal meningitis outside endemic regions. Clinicians should therefore obtain a patient’s travel history even if the patients have only a remote travel history.
SN - 1349-7235
SN - 0918-2918
ER -