KMID : 1144320120440020075
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°¨¿°°ú ÈÇпä¹ý 2012 Volume.44 No. 2 p.75 ~ p.79
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A Case of Coccidioidal Meningitis
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Lee Jung-Woo
Kim Sang-Il Kim Youn-Jeong Kwon Jae-Cheol Lim Ye-Jee Park Mi-Hee Kim Seon-A Koh Eun-Sil Kim Min-Ju Kang Moon-Won
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Abstract
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A 35-year-old man with known coccidioidal meningitis developed a severe headache and vomiting during routine treatment. Hydrocephalus was visible on brain imaging, and CSF study revealed pleocytosis, lowering of glucose, and increased intracranial pres¡þsure. Dexamethasone and mannitol was used for intracranial pressure control. In¡þtrathecal amphotericin B administration and switching to itraconazole resulted in gradual improvement of symptoms. After 4 months of discontinuing amphotericin B intrathecal administration, the patient developed severe headaches with vomiting, diplopia and tandem gait. Coccidioidal meningitis aggravation was suspected based on brain MRI and CSF studies. Ventriculo-peritoneal shunt insertion was per¡þformed for intracranial pressure control and the combined therapy of intrathecal amphotericin B administration and fluconazole was maintained. This combined regimen kept the meningitis stable for 1 month.
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KEYWORD
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Coccidioidomycosis, Meningitis, Intrathecal, Amphotericin B
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