The Upside of Bias: A Case of Chronic Meningitis Due to in an Immunocompetent Host.

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. Although is a recognized and treatable cause of chronic meningitis, neurologists and infectious diseases physicians may not regularly evaluate for infection. 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 for antibodies from the cerebrospinal fluid, which were positive. His clinical and functional status improved, and the antibody titer decreased with itraconazole therapy. Clinicians should consider in the differential diagnosis for chronic meningitis, even in immunocompetent patients, particularly when the clinical picture does not respond to standard empiric therapy.