title: Disseminated coccidioidomycosis presenting with intramedullary spinal cord abscesses: Management challenges.
abstract: Coccidioides species are endemic to the southwestern United States and typically cause a mild or asymptomatic primary infection. In some instances, infection can disseminate and involve the central nervous system with meningitis being the most common manifestation. Non-osseous spinal cord involvement is exceedingly rare. We report a case of disseminated coccidioidomycosis in an otherwise healthy 20 year old man with diffuse leptomeningeal enhancement, cerebrospinal fluid findings suggestive of meningitis, and intramedullary spinal cord abscesses. Response to treatment occurred with prolonged systemic liposomal amphotericin B and voriconazole. An extended course of steroids was needed to blunt inflammation.
authors.affiliation: Department of Medicine, Divison of Allergy and Infectious Diseases, University of Washington, 1959 NE Pacific Street Box 356423, Seattle, WA 98195, USA.
authors.forename: Kristina L
authors.initials: KL
authors.lastname: Bajema
authors.affiliation: Department of Radiology, University of Washington, Seattle, WA, USA.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Dalesandro
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: David N
authors.initials: DN
authors.lastname: Fredricks
authors.affiliation: Department of Medicine, Divison of Allergy and Infectious Diseases, Harborview Medical Center, Seattle, WA, USA.
authors.forename: Meena
authors.initials: M
authors.lastname: Ramchandani
keywords: Coccidioides; disseminated coccidioidomycosis; intramedullary spinal cord abscess; meningitis