Isolated central nervous system histoplasmosis in an immunocompetent patient: 53-month hiatus to diagnosis and treatment

Chronic meningitis may result from a wide range of etiologies, both infectious and noninfectious, and is often diagnostically challenging. In most series, tuberculosis remains the most common recognized cause. Of the fungal diseases resulting in chronic meningitis, Cryptococcus is the most common. When untreated, the infectious meningitides typically exhibit an inexorably progressive course with high morbidity and mortality. We report a patient with chronic meningitis due to Histoplasma capsulatum who exhibited a remarkably benign course despite being untreated for the disorder for more than 4 years.