ASSOCIATION BETWEEN FACIAL CUTANEOUS COCCIDIOIDOMYCOSIS AND MENINGITIS

The skin is frequently a site of extrapulmonary dissemination in patie nts with coccidioidomycosis. Clinical experience in an endemic area su ggests an association between facial cutaneous coccidioidomycosis and meningitis. Awareness of this association is important because coccidi oidal meningitis is the most ominous site of spread in coccidioidomyco sis. In this study, we assess whether cutaneous dissemination involvin g the face is associated with meningitis to a greater degree than that limited to the body. We retrospectively reviewed the medical records of 201 patients from 1987 to 1996 with disseminated coccidioidomycosis and found 30 patients with cutaneous involvement. Their mean age was 29.5+/-11.6 years; 20 patients were male; 14 were African American, 12 were Hispanic, 3 were white, and 1 was Asian. Nineteen patients had f acial involvement, and 11 had isolated body involvement. Meningitis de veloped in 11 patients, 10 with facial involvement and 1 with only bod y involvement. Patients with facial lesions were more likely to have m eningitis (odds ratio, 11.1; 95% confidence interval, 1.1 to 529, P=.0 23). The identification of a subgroup of patients at significant risk of developing meningitis may allow earlier detection and perhaps impro ved management of patients with meningeal disease.