Hong Liu Kaixin Zhou Chaoran Zhong Ming Guan ^*

• Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, Shanghai Municipality, China

Coccidioides spp. endemic in Southwestern United States and Central and South America. Here we report a case of Coccidioides immitis induced meningitis in a 27year-old male who suffering from recurrent fever and headache. His Cerebrospinal fluid (CSF) biochemical markers reflect central nervous system infection, however, repeated routine cultures using CSF for bacteria were all negative, only metagenomic nextgeneration sequencing (mNGS) detected low reads of C. immitis. For verifying the mNGS results, clinical microbiology laboratory of Huashan hospital optimized its culture condition. Ultimately, 12 days after sampling, the fungal bottle containing cerebrospinal fluid reported positive. Further, the diagnosis of C. immitis was then confirmed by smear staining combined with the morphological characteristics of the colony, which provided an important etiological basis for clinical diagnosis and treatment. As coccidioidomycosis is a rare disease in China, its pathogen specific diagnosis methods are limited. In this case, we combined two universal methods, mNGS and traditional morphological observation to confirm it. This combined strategy is critical to quick and accurate diagnosis.