Disseminated Coccidioidomycosis Complicated by Vasculitis: A Cause of Fatal Subarachnoid Hemorrhage in Two Cases

Summary: We describe two cases of disseminated coccidi-oidomycosis that were complicated by fatal subarachnoid hemorrhage. In the first case, a left middle cerebral artery aneurysm and long-segment vasculitis occurred. In the sec-ond case, MR imaging revealed an enlarging coccidioidal granuloma at the tip of the basilar artery, and the artery subsequently ruptured. Fatal intracranial hemorrhage is a rare complication of disseminated coccidioidomycosis. The fungus Coccidioides immitis resides in the topsoil of the Southwestern United States and Northern Mexico. There are an estimated 60,000 to 80,000 new cases of coccidioidomycosis every year, with disseminated disease occurring in less than 1 % of the population (1). Although vasculitis may occur, it more commonly causes ischemia and not hemorrhage (2, 3). Fatal intracranial hemor-rhage is rare and, to our knowledge, has been re-ported as occurring in only one patient (4). We de-scribe two cases of fatal intracranial hemorrhage, one resulting from direct invasion of the basilar ar-tery and the second from rupture of a mycotic an-eurysm in a patient without meningitis. Case Report