COCCIDIOIDAL MENINGITIS OF LONG DURATION: REPORT OF A CASE OF FOUR YEARS AND EIGHT MONTHS' DURATION, WITH NECROPSY FINDINGS

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Abstract
A case report of coccidioidal meningitis of 56 months'' duration is presented, the longest reported duration for this uniformly fatal disease. Although the patient had been extensively studied during previous hospitalizations elsewhere, the correct diagnosis was not reached until specific studies for coccidioidomycosis were undertaken in the 5th yr. of illness. Coccidioidal meningitis was then diagnosed by specific complement-fixation studies, and by recovery of Coccidioides immitis from spinal fluid. Necropsy revealed evidence of old coccidioidal pulmonary infection in hilar lymph nodes, in addition to the anticipated findings in the meninges. Diagnostic considerations are discussed in detail, with emphasis on the value of serol. studies of blood and spinal fluid, marked rise in spinal fluid protein, first zone elevation of the gold curve, and geographic history of exposure.