Abstract
Coccidioidal meningitis is a rare yet life-threatening complication of disseminated Coccidioides infection, primarily affecting immunocompromised individuals. Coccidioides immitis and Coccidioides posadasii are dimorphic fungi endemic to the southwestern United States, where exposure to inhaled spores can lead to a range of clinical manifestations, including pulmonary and central nervous system (CNS) involvement. This report describes the case of a 27-year-old correctional officer with advanced human immunodeficiency virus (HIV) infection who presented with chronic headaches, altered mental status, and significant weight loss following his relocation from Arizona to Louisiana. Cerebrospinal fluid (CSF) analysis revealed slow-growing mold consistent with Coccidioides species, leading to the diagnosis of coccidioidal meningitis. This case emphasizes the importance of considering fungal meningitis in patients with compatible geographic exposure and immunosuppression.