Abstract Background Coccidioides meningitis is a life-threatening complication with Coccidioides spp., that requires lifelong antifungal therapy. While some cases respond to azoles, others are refractory and require periodic treatment with intravenous (IV) and/or intrathecal (IT) amphotericin B. MAT2203 is a novel formulation of amphotericin B that uses a rolled phosphatidylserine lipid nanocrystal (LNC) bilayer that is orally absorbed. MAT2203 has been successfully used to treat Cryptococcal meningitis and Histoplasma meningitis Case Presentation In 2017 this previously healthy construction worker developed coccidioidal pneumonia and meningitis and was treated with liposomal amphotericin B and oral fluconazole. His pneumonia resolved but his meningitis worsened. Imaging showed vasculitis of his middle cerebral artery and arachnoiditis at base of brain and eventually throughout his spine. He required multiple changes in azoles and eventually an Ommaya reservoir so he could receive periodic IT amphotericin plus corticosteroids while continuing oral isavuconazole. Treatment response was monitored with symptoms, CSF cell counts, CSF Coccidioides antigen, and imaging. Frequency of IT treatment varied over the course of his illness from 3 times/week to monthly, increasing with symptom flares. The patient also failed a trial of the investigational antifungal olorofim. In 2024, one month after his last dose of IT amphotericin, the patient started treatment with MAT2203. After 6 months of MAT2203 (without any IT or IV amphotericin), Coccidioides antigen in the ventricular CSF was undetectable for the first time and remained so with normalization of glucose and cell counts Conclusions MAT2203 may offer an oral therapeutic option for refractory cases of Coccidioides meningitis.
Mehta et al. (Fri,) studied this question.