# Atypical Parkinsonism: An Uncommon Presentation of Disseminated Coccidioidomycosis

## TL;DR

A man with atypical Parkinsonism symptoms was later diagnosed with a rare fungal infection affecting the brain, highlighting the varied and severe presentations of coccidioidomycosis.

## Contribution

This case highlights an unusual neurological presentation of disseminated coccidioidomycosis and emphasizes the need for early detection strategies.

## Key findings

- Atypical Parkinsonism symptoms can be an early sign of disseminated coccidioidomycosis.
- MRI findings showed brain and spinal abnormalities before a definitive diagnosis was made.
- High antibody levels in serum and cerebrospinal fluid confirmed the diagnosis.

## Abstract

Coccidioidomycosis is endemic in the southwestern United States, Central America, and South America. Coccidioidomycosis has a variety of clinical presentations. Coccoidal meningitis is a feared form of disseminated coccidioidomycosis with high mortality and mobility rates. We reported a case of a 64-year-old man who presented with a three-week history of gait abnormalities and back pain. The patient had atypical parkinsonism, signs of cogwheeling rigidity, a masked face, intention tremor, a shuffling gait, upgazed restriction, and long track signs of left Babinski. MRI of the brain and cervical spine demonstrated scattered foci of abnormal parenchymal and leptomeningeal enhancement. The patient later developed acute cerebral infarction before a definite diagnosis of disseminated coccidioidomycosis, which was made when the result was that serum and cerebrospinal fluid coccidioidomycosis antibodies were high. The patient started lifelong antifungal treatment. We provide a natural disease process from atypical parkinsonism to cerebral infarction to hydrocephalus to enhance awareness of the myriad clinical presentations, emphasize the importance of endemic mycoses awareness, and also put forward a question of what can be done to detect coccidioidomycosis early.