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.

Methicillin-Resistant Staphylococcus aureus Bacteremia of Indeterminate Primary Source: A Case Report and Review of Pain Management During Hospital Course.

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacteria that is present in both hospital and community settings. It commonly spreads through direct contact but may also spread through droplets. Our body's innate and adaptive immunity is typically enough to protect against MRSA entering our body. MRSA has an increased ability to enter and spread throughout the body with the use of infected objects such as needles or even small breaks in the skin. When this spread occurs hematogenously, it is known as MRSA bacteremia. When a patient presents with MRSA bacteremia, it is a critical time-sensitive task to locate the source of infection as continual exposure to MRSA in the bloodstream can prolong infection and may ultimately be fatal. The interesting obstacle in our patient presenting with MRSA bacteremia was the inability to locate a source of infection, a pivotal component of medical management. After extensive testing and detailed history taking, there was no possible external source of infection, making source control a difficult task. Another unique component of this case report included the course of pain management and adjustments made to tailor pain control to this patient with a history of chronic opioid abuse.