2025 American Academy of Neurology Abstract Website

Objective:

To examine the effects of antifungal and corticosteroid therapy in patients with coccidioidal meningitis (CM) and vasculitis.

Background:

Coccidiodal vasculitis is a serious complication of coccidioidal infection that can occur in patients with CM. There is little data about the role and timing of corticosteroid therapy in patients with coccidioidal associated vascular events.

Design/Methods:

This study was granted IRB exemption. We used the Stanford Research Data Repository to review deidentified patient charts of all patients with a diagnosis of “cocci meningitis”. Charts were manually reviewed. Patients with an admission for coccidioidal meningitis with available records were included. Variables collected included demographics, admitting service, laboratory data, imaging findings, treatments, and derived modified Ranken scores.

Results:

There were 140 patients whose charts were reviewed. Of those, 73 patients were included in the analysis. Patients were excluded if primary admission was not for CM or insufficient data available. 22/73 (30%) of patients with CM also developed coccidioidal vasculitis. All patients were treated with antifungals. 34 patients were treated with some form of concurrent corticosteroid therapy during their disease course. Of the patients with vasculitis, only 4 patients were not treated with corticosteroid therapy. Most patients were discharged home or to an acute rehab unit, 7 patients died and 1 was transitioned to comfort care.

Conclusions:

Mortality for CM has decreased significantly after the advent of antifungal and better detection of the disease, however, complications such as hydrocephalus and vasculitis continue to afflict patients with serious consequences. Steroids were commonly used in our patients and may prevent worsening in addition to antifungal therapy. Further studies are needed to determine the best course of therapy to prevent complications and improve outcomes.