PMC10286156_01
CT and MRI findings showing disseminated coccidioidomycosis basilar meningitis with communicating hydrocephalus and left lower lobe primary pulmonary nodule. (A) CT brain without contrast showing diffuse ventriculomegaly without trans-ependymal flow, consistent with hydrocephalus. (B) MRI brain sagittal view on T1 postcontrast sequence showing extensive basilar meningitis and communicating hydrocephalus. (C) CT thorax without contrast showing 3 mm left lower lobe pulmonary nodule.. Abbreviations: CT, computerized tomography; MRI, magnetic resonance imaging.
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In our ED, a CT of the head showed ventriculomegaly with hydrocephalus (Figure 1A). Subsequently, an MRI of the brain confirmed extensive basilar meningeal enhancement with communicating hydrocephalus (Figure 1B). Coccidioides enzyme immunoassay (EIA) IgG antibody, positive Coccidioides immunodiffusion (IMDF) IgM tube precipitin antibody, positive Coccidioides IMDF IgG complement fixation (CF) antibody, serum Coccidioides CF titer of 1:128, and CSF Coccidioides CF titer of 1:32. Computed tomography thorax imaging also identified a 3-mm left lower lobe pulmonary nodule without parenchymal consolidation, cavitary lesion, or pleural effusion (Figure 1C).
Repeat MRI brain after 4 months of exclusive medical management showing interval improvement of basilar meningitis with decreased communicating hydrocephalus. (A) MRI brain sagittal view in T1 postcontrast showing interval improvement in basilar meningitis. (B-C) MRI brain coronal view in T1 MP-RAGE postcontrast showing interval reduction in hydrocephalus.. Abbreviations: MRI, magnetic resonance imaging; MP-RAGE, Magnetization Prepared - RApid Gradient Echo.
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Since discharge, he has been closely monitored for any progression of his intermittent headaches or further clinical signs of neurologic impairment and completed repeat brain MRI imaging (Figure 2A-C).