Don't drink in the valley.
A 39-year-old man presented with chronic headaches and intermittent blurred vision with previous neuroimaging and blood work that was reportedly normal. He had papilledema and further questioning elicited a history of extensive alcohol use, unexplained weight loss, and night sweats. Magnetic resonance imaging of the brain demonstrated communicating hydrocephalus and leptomeningeal enhancement. The patient underwent ventriculoperitoneal shunt placement and leptomeningeal biopsy, which was initially unrevealing. Cerebrospinal fluid eventually yielded positive titers for coccidioides, a diagnosis that was confirmed by biopsy culture results.
Baylor College of Medicine, Houston, Texas, USA.
Robert B
RB
Garoon
Baylor College of Medicine, Houston, Texas, USA. Electronic address: foroozan@bcm.edu.
Rod
R
Foroozan
UAB Department of Ophthalmology, Birmingham, Alabama, USA.
Michael S
MS
Vaphiades
D000328:Adult; D003047:Coccidioidomycosis / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D016921:Meningitis, Fungal / Q000150:complications* / Q000175:diagnosis; D010211:Papilledema / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D017287:Ventriculoperitoneal Shunt
chronic headache; coccidioidal meningitis; disk edema; fluconazole; peripapillary exudates