title: The Upside of Bias: A Case of Chronic Meningitis Due toSporothrix Schenckiiin an Immunocompetent Host.
abstract: Chronic meningitis of unknown etiology is a vexing illness for patients and clinicians. Identification of the correct pathogen can be challenging and time consuming, leading to delays in appropriate treatment. AlthoughSporothrix schenckiiis a recognized and treatable cause of chronic meningitis, neurologists and infectious diseases physicians may not regularly evaluate forSporothrixinfection. We describe an immunocompetent patient with chronic meningitis who partially responded to empiric fluconazole. Prompted by a recent culture-confirmed case of meningeal sporotrichosis, we tested forS schenckiiantibodies from the cerebrospinal fluid, which were positive. His clinical and functional status improved, and theS schenckiiantibody titer decreased with itraconazole therapy. Clinicians should considerS schenckiiin the differential diagnosis for chronic meningitis, even in immunocompetent patients, particularly when the clinical picture does not respond to standard empiric therapy.
authors.affiliation: Department of Neurology, University of California, San Francisco, CA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Hessler
authors.affiliation: Infectious Diseases Section, Veterans Affairs Ann Arbor Healthcare System, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Kauffman
authors.affiliation: Department of Neurology, University of California, San Francisco, CA, USA; Infectious Diseases, Department of Medicine, University of California, San Francisco, CA, USA.
authors.forename: Felicia C
authors.initials: FC
authors.lastname: Chow
keywords: Sporothrix schenckii; central nervous system infection; chronic meningitis; fungal; sporotrichosis