Cerebrovascular Accident Caused by Coccidioides immitis Basilar Meningitis in a Patient with Stroke Risk Factors.

A 57-year-old female with a history of type 2 diabetes mellitus and hypertension presented to the emergency department on multiple occasions with neurologic symptoms due to multiple embolic strokes of unclear etiology. While participating in inpatient rehabilitation, she subsequently developed fever and shaking chills. Infectious disease consultation was obtained, during which the patient reported travel to Mexico two months prior. Further diagnostic testing revealed basilar-predominant leptomeningeal enhancement and serum fungal antibody testing returned positive for Coccidioides immitis. This led to a diagnosis of Coccidioides immitis with secondary vasculitis causing multifocal ischemic stroke. The patient's neurologic function has returned to normal after treatment with fluconazole, and life-long treatment with fluconazole is planned. This case underscores the importance of obtaining a travel history.