Pediatric coccidioidomycosis meningitis with hydrocephalus and pancreatitis

Kim, J.;Sporer, R.;Jean, B.;Peck, R.


A case of a 10-year-old Filipino girl with a 1-month history of worsening: headache, persistent intermittent fever, blurry vision, photophobia, and emesis upon eating, is presented with an analysis af trends in the laboratory data. Results of her initial Coccidiodes immitis complement fixation titers (CFT) of serum and cere brospinal fluid (CSF) were 1:64 and 1:4, respectively, and she was given intravenous and intrathecal amphotericin B. Complement fixation titers rapidly peaked, then gradually declined during convalescence. Serum CFT rose to a maximum (1:512) at 4 weeks, with another peak value (1:512) at 14 weeks. Cerebrospinal fluid CFT rose to 8 maximum (1:64) at 14 weeks, By 57 weeks, CFT in serum and CSF stabilized at 1:32 and 1:8, respectively.Her clinical course was complicated by a communicating hydrocephalus, and by a pancreatitis, Although the definitive etiology of her pancreatitis remained elusive, measures of coccidioidomycosis infection showed a direct correlation with the indices of pancreatitis, While other correlations existed with therapy (cimetidine, famotidine, parenteral nutrition, phenytoin), the variables involved in other treatment (using amphotericin, fluconazole, corticosteroids) remained constant.Several important trends in laboratory data were revealed by this case, and produced a logarithmic relation used in comparing the kinetics of the serum and cerebrospinal fluid complement fixation titers, We suggest an increased focus on identifying the peak of illness in order to further study this mathematical relation, and suggest increased awareness and surveillance of the complications that may result from therapeutic modalities and or the illness itself.

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Full conference title: 

Coccidioidomycosis - Centennial Conference
    • Coccidioidomycosis