Abstract Details

Title Subarachnoid Hemorrhage and Cerebral Edema Caused by Disseminated Coccidiomycosis: A Case Report

Topic Infectious Disease

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 225

Objective This case report aims to demonstrate a rare etiology that can cause subarachnoid hemorrhage, and that diagnosing and treating the underlying cause can lead to a favorable outcome, despite the ominous presentation.

Background A thirty-six-year-old African-American male was found on the ground with a reduced level of consciousness. Non-contrast CT of the head revealed diffuse subarachnoid hemorrhage involving the basilar cisterns and bilateral sylvian fissures, as well as cerebral edema with loss of sulci and effacement of basilar cisterns. Two CT angiograms and a digital subtraction angiogram revealed only a distal 2 mm aneurysm that did not appear to be causative for the hemorrhage. CT imaging throughout the patient’s body revealed a mediastinal mass and many lytic bone lesions.

Design/Methods The patient was given standard of care treatment for aneurysmal subarachnoid hemorrhage, including nimodipine, atorvastatin, and 3% hypertonic saline. His fluid intake and output were strictly monitored, as well as daily transcranial doppler ultrasounds. An external ventricular drain was placed to reduce intracranial pressure. Despite adequate treatment and no evidence of vasospasm, the patient continued to exhibit waxing and waning mentation and hallucinations. A bone lesion biopsy contained fungus spherules consistent with coccidioides. CSF samples were found positive for coccidioides IgG, IgM, and fungitell, as well as an elevated titer of coccidioides antibodies.

Results The patient was diagnosed with disseminated coccidiomycosis and treated with both intravenous and intrathecal amphotericin B, with improvement in mentation. His hemorrhage and cerebral edema resolved with no residual neurologic deficits. The patient was discharged in good condition four weeks after admission.

Conclusions Although aneurysmal rupture is a common culprit for nontraumatic subarachnoid hemorrhage, in this case there was sufficient evidence that the aneurysm found on imaging did not explain the patient’s presentation, and another underlying pathology should be sought. With appropriate treatment, this patient had a good outcome.

Authors/Disclosures
Taylor S. Campbell, DO (Valley Hospital Medical Center) PRESENTER	Dr. Campbell has nothing to disclose.
Trusha Mehta, DO (Valley Hospital)	Dr. Mehta has nothing to disclose.
Paul H. Janda, DO, JD, Wharton MBA, FAAN (Las Vegas Neurology Center)	Dr. Janda has nothing to disclose.
Aroucha Vickers, DO, FAAN (Las Vegas Neurology Center)	Dr. Vickers has nothing to disclose.
Alan A. Arismendez, DO (Rio Grande Regional Hospital)	Dr. Arismendez has nothing to disclose.
Mckenzie Merritt, DO	Dr. Merritt has nothing to disclose.

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