The University of Arizona College of Medicine - Tucson, Tucson, AZ, USA.
J Investig Med High Impact Case Rep. 2023 Jan-Dec;11:23247096231181060. doi: 10.1177/23247096231181060.
Disseminated coccidioidomycosis is associated with significant morbidity and mortality. Involvement of the meninges is often fatal if untreated, typically requiring lifelong antifungal therapy and neurosurgical intervention. We present the case of a young male without any known immunocompromising conditions who opted exclusively for medical management of newly diagnosed coccidioidomycosis meningitis with communicating hydrocephalus and discuss the controversy associated with this approach. This case highlights the importance of shared decision-making between patient and clinician, even if the plan diverges from available guidelines. Furthermore, we discuss clinical considerations in approaching the close outpatient monitoring of patients with central nervous system coccidioidomycosis with hydrocephalus.
播散性球孢子菌病与显著的发病率和死亡率相关。如果未经治疗，脑膜受累通常是致命的，通常需要终身抗真菌治疗和神经外科干预。我们报告了一例年轻男性病例，他没有任何已知的免疫功能低下情况，选择仅对新诊断的伴有交通性脑积水的球孢子菌病脑膜炎进行药物治疗，并讨论了这种方法相关的争议。该病例强调了患者和临床医生之间共同决策的重要性，即使该方案与现有指南存在差异。此外，我们还讨论了在对伴有脑积水的中枢神经系统球孢子菌病患者进行密切门诊监测时需要考虑的临床因素。
