CENTRAL-NERVOUS-SYSTEM ABSCESSES DUE TO COCCIDIOIDES SPECIES

Meningitis occurs in one-third to one-half of patients with disseminat ed coccidioidomycosis, but mass lesions have rarely been described; th ese lesions are usually found at autopsy, We report six cases of disse minated coccidioidomycosis with central nervous system (CNS) abscesses , Four patients had cerebellar involvement, and two had spinal cord in volvement. Four patients were diabetic, and two subsequently died, Rev iew of the literature on CNS coccidioidomycosis indicated that parench ymal brain involvement occurs in 1%-33% of cases, and <40 cases with m ass lesions have been reported since 1905, Almost all patients were ma te and had other active disseminated foci of coccidioidomycosis, In ap proximately one-third of all cases, meningitis was absent. Brain lesio ns may be superficial or deep and multiple or single, In the absence o f meningitis, serology of cerebrospinal fluid is negative, Hematogenou s origin appears to be more common than direct extension from the meni nges. Spinal cord involvement is rare. Diabetes was present in several cases, thus suggesting a vascular predisposition, We hope our experie nce will increase awareness of this entity, which appears to be more c ommon than previously appreciated, and will facilitate diagnosis.