Posters
Presenting Author Academic/Professional Position
Hugo Zamarron
Academic Level (Author 1)
Medical Student
Discipline/Specialty (Author 1)
Neurology
Academic Level (Author 2)
Fellow
Discipline/Specialty (Author 2)
Neurology
Discipline Track
Clinical Science
Abstract Type
Case Report
Abstract
Background: Cerebral small vessel strokes in young, otherwise healthy adults without traditional vascular risk factors are rare and warrant further investigation. Central nervous system (CNS) vasculitis is an uncommon etiology that may be triggered by infections, including fungal pathogens. This case is notable for a suspected primary CNS vasculitis manifesting as bilateral deep infarcts in the setting of Coccidioidal meningitis. It highlights the importance of considering fungal infections and vasculitis in the differential diagnosis of stroke in younger patients.
Case Presentation: A 32-year-old previously healthy male presented with fever, headache, and was diagnosed with aseptic meningitis. He was later readmitted with persistent symptoms and subsequently developed left-sided weakness and altered mentation. Initial imaging and neurologic examination were indefinite, but further evaluation revealed acute infarcts in the right thalamus and left basal ganglia, consistent with small vessel territory strokes. There were no traditional risk factors for stroke. Lumbar puncture showed elevated opening pressure, and cerebrospinal fluid studies were consistent with fungal meningitis. Serologic testing returned positive for Coccidioides antibodies. MRI angiography was unremarkable, and a brain biopsy was deferred due to clinical improvement. The patient was treated empirically with intravenous corticosteroids and antifungal therapy. His neurologic status improved rapidly, and follow-up imaging showed resolution of infarct-related edema. His final neurological examination was at baseline, and he was discharged on a steroid taper and oral antifungals.
Conclusions: This case illustrates a rare presentation of suspected CNS vasculitis secondary to fungal meningitis in a young adult without vascular risk factors. Early recognition and empiric treatment with corticosteroids and antifungals led to favorable outcomes. Clinicians should maintain a high index of suspicion for infectious and inflammatory causes of stroke in young patients, particularly in endemic regions for fungal infections. This case also reinforces the diagnostic challenge posed by small vessel CNS vasculitis and the importance of pursuing aggressive but balanced diagnostic and therapeutic approaches.
Presentation Type
Poster
Recommended Citation
Zamarron, Hugo and Ali, Ahsan, "Bilateral Small Vessel Strokes in a Young Male With Coccidioidal Meningitis and Suspected CNS Vasculitis" (2025). Research Colloquium. 47.
https://scholarworks.utrgv.edu/colloquium/2025/posters/47
Included in
Bacterial Infections and Mycoses Commons, Diagnosis Commons, Internal Medicine Commons, Nervous System Commons, Nervous System Diseases Commons, Neurology Commons, Neurosciences Commons, Radiology Commons
Bilateral Small Vessel Strokes in a Young Male With Coccidioidal Meningitis and Suspected CNS Vasculitis
Background: Cerebral small vessel strokes in young, otherwise healthy adults without traditional vascular risk factors are rare and warrant further investigation. Central nervous system (CNS) vasculitis is an uncommon etiology that may be triggered by infections, including fungal pathogens. This case is notable for a suspected primary CNS vasculitis manifesting as bilateral deep infarcts in the setting of Coccidioidal meningitis. It highlights the importance of considering fungal infections and vasculitis in the differential diagnosis of stroke in younger patients.
Case Presentation: A 32-year-old previously healthy male presented with fever, headache, and was diagnosed with aseptic meningitis. He was later readmitted with persistent symptoms and subsequently developed left-sided weakness and altered mentation. Initial imaging and neurologic examination were indefinite, but further evaluation revealed acute infarcts in the right thalamus and left basal ganglia, consistent with small vessel territory strokes. There were no traditional risk factors for stroke. Lumbar puncture showed elevated opening pressure, and cerebrospinal fluid studies were consistent with fungal meningitis. Serologic testing returned positive for Coccidioides antibodies. MRI angiography was unremarkable, and a brain biopsy was deferred due to clinical improvement. The patient was treated empirically with intravenous corticosteroids and antifungal therapy. His neurologic status improved rapidly, and follow-up imaging showed resolution of infarct-related edema. His final neurological examination was at baseline, and he was discharged on a steroid taper and oral antifungals.
Conclusions: This case illustrates a rare presentation of suspected CNS vasculitis secondary to fungal meningitis in a young adult without vascular risk factors. Early recognition and empiric treatment with corticosteroids and antifungals led to favorable outcomes. Clinicians should maintain a high index of suspicion for infectious and inflammatory causes of stroke in young patients, particularly in endemic regions for fungal infections. This case also reinforces the diagnostic challenge posed by small vessel CNS vasculitis and the importance of pursuing aggressive but balanced diagnostic and therapeutic approaches.
