Spinal Coccidioidomycosis: A Complication From Medication Noncompliance

Surav M Sakya,Irfan Warraich,Judy P Sakya,David R Hallan

doi:10.7759/cureus.9304

Abstract

Spinal coccidioidomycosis is a rare disseminated form of coccidioidomycosis infection. According to the literature, majority of patients are African American males. We present a rare case of spinal coccidioidomycosis in a young, Caucasian female with coccidioidomycosis meningitis at age 16 years who presented with bilateral lower extremity weakness after antifungal medication lapse for one year. Imaging revealed cystic arachnoid formations along her thoracic spine. Pathology report confirmed spinal arachnoiditis with coccidioidomycosis. This case report details a rare incidence of spinal coccidioidomycosis and reviews previous literature.

Highlights

We present a rare case of spinal coccidioidomycosis in a young, Caucasian female with coccidioidomycosis meningitis at age 16 years who presented with bilateral lower extremity weakness after antifungal medication lapse for one year
Spinal coccidioidomycosis is a rare condition caused by hematogenous systemic dissemination of Coccidioides species
Even though most patients are African American males, it is important to recognize the importance of medical history and place of residence for prompt diagnosis and treatment of spinal coccidioidomycosis

Summary

Introduction

Spinal coccidioidomycosis is a rare condition caused by hematogenous systemic dissemination of Coccidioides species. Coccidioidomycosis, a fungal infection commonly known as Valley fever, is endemic to the southwestern region of the United States This respiratory illness, generally caused by fungal organisms Coccidioides immitis or Coccidioides posadasii, often presents as community-acquired pneumonia with fever and cough [1]. We present a rare case of a spinal coccidioidomycosis in a 24year-old, Caucasian female. The patient had been previously diagnosed with coccidioidomycosis meningitis at age 16 years and was on daily antifungal medication. She denied any fever, chills, dysuria and upper extremity weakness. CSF and serum complement fixed Ab were positive for coccidioidomycosis (1:128 titer and 1:16 titer, respectively), and IgM and IgG were both positive Her thoracic MRI showed enhancing septations within the thecal sac in the thoracic region, resembling cystic arachnoid formations (Figure 1). The patient is encouraged to continue rehab and medication adherence

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Disclosures