Disseminated Blastomycosis With Meningeal Involvement

Abstract

DISSEMINATED blastomycosis of the North American variety is usually fatal if not treated. Despite the markedly improved prognosis which was occasioned by the discovery that the etiological agent in this entity was quite sensitive to amphotericin B, a disseminated infection with central nervous system (CNS) involvement still portends a serious prognosis with an uncertain outcome. Although this entity is the most responsive of the deep mycoses to treatment, meningeal involvement is difficult to eradicate with intravenous amphotericin B alone because of the low concentration attained in the cerebrospinal fluid.^1,2The latter is a manifestation of the drug's inability to penetrate the blood-brain barrier. Therefore, the intrathecal route of administration has been advocated in this and several other fungal disorders when there is involvement of the brain or meninges, or both. While improving the chances for complete cure, the incidence of serious neurologic sequelae resulting from intrathecal administration has