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KMID : 1144320120440020075
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감염과 화학요법
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￢sure. Dexamethasone and mannitol was used for intracranial pressure control. In￢trathecal 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￢formed 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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