A Case of Rapidly Progressive Coccidioidal Meningitis in an Immunocompetent Patient.

A 50-year-old male with a history of a dull headache and neck pain for a few weeks presented to the ER with complaints of progressive weakness and difficulty walking. Physical examination revealed a lethargic, confused patient with abnormal tremors at rest. Initial lab work was significant for elevated hemoglobin, hematocrit, and hyponatremia. Additionally, CT imaging was significant for prominent ventricles. Several serologies and polymerase chain reaction (PCR) tests were ordered to determine the etiology of the patient's meningitis. On day 10 of admission, serology results returned positive for Coccidioides antibodies. The patient was started on an IV fluconazole treatment and underwent a ventriculoperitoneal shunt and Ommaya reservoir placement procedure. Cases of coccidioidal meningitis are rarely noted in recent literature. We present this clinical case of coccidioidomycosis dissemination into the central nervous system (CNS) to highlight the rare localization of the fungal infection in a baseline immunocompetent patient.

Peripheral Thromboembolism Formation in a Case of Takotsubo Cardiomyopathy.

Takotsubo cardiomyopathy (TC) is a reversible cardiac disorder of the elderly commonly seen in postmenopausal women. TC can present similar to acute coronary syndrome with chest pain and dyspnea; however, there is no coronary artery occlusion. Patients with TC classically show ventricular apical ballooning and hypokinesis on echocardiogram. Few cases of thromboembolism of the lower extremity due to Takotsubo have been reported in the literature. Here, we report a unique occurrence of a thromboembolism formation in the right common iliac and external iliac arteries in the context of TC. Through the mechanisms of TC that involve ventricular wall abnormalities, hypercoagulability, and catecholamine excess, thromboembolism in the iliac system was likely from the akinetic ventricle. In this case, computed tomography angiography was an essential diagnostic tool that revealed the peripheral occlusion; therefore, it should be considered in patients with a history of TC who complain of lower extremity pain and neurological symptoms.