Coccidioides species are dimorphic fungi endemic to southwestern USA and northern Mexico. Disseminated
coccidioidomycosis is rare with an estimated incidence of 1% in affected individuals and usually presents as
meningitis when the central nervous system is involved. Spinal involvement with
coccidioidomycosis, though not uncommon, predominantly manifests as osseous involvement leading to
osteomyelitis and
epidural abscess formation. Progressive
quadriparesis as a presenting symptom secondary to intramedullary spinal cord
coccidioidomycosis is very unusual and to our knowledge has not been described. We report a patient with disseminated
coccidioidomycosis who presented with rapidly progressive
quadriparesis due to cervical intramedullary spinal cord involvement. The absence of known
coccidioidomycosis with atypical clinical presentation made the diagnosis elusive, requiring emergent cervical
laminectomies with dural biopsy for
decompression of the spinal cord and confirmation of the diagnosis. The patient eventually succumbed to the progressive course of the disease. Although rare, disseminated
coccidioidomycosis can present as new, rapidly progressing
quadriparesis in patients who have traveled to endemic areas. A high index of suspicion in such patients with appropriately directed laboratory investigations and consideration of early biopsy might unravel the diagnosis facilitating early antifungal treatment with the potential to minimize morbidity and mortality associated with disseminated
coccidioidomycosis.