Coccidioides spp is a soil-dwelling, dimorphic fungus that causes coccidioidomycosis. It
is endemic to the western hemisphere. Although primarily a respiratory disease, it can
also cause a myriad of clinical manifestations, from asymptomatic disease to meningitis.
In fact, Coccidioides species is probably the most common etiologic agent of long-term
meningitis in California and Arizona. Early diagnosis and treatment are critical to avoid
fatal complications. With treatment, the cerebral spinal fluid analysis may return to
normal. Relapse of coccidioidal meningitis is usually suspected with recurrence of
meningitis symptoms. The patient is a 53-year-old man with a 2-decade history of
coccidioidal meningitis who was diagnosed with an asymptomatic relapse of coccidioidal
meningitis.