Sarocladium strictum (S. strictum) meningitis is a rare but rapidly progressive and often fatal central nervous system (CNS) infection, typically presenting with nonspecific symptoms such as headache, fever, and limb weakness, making early diagnosis difficult. We report a 42-year-old woman with a history of sarcoidosis and prior immunosuppressive therapy who developed fever and headache during travel in Inner Mongolia, China. Initially misdiagnosed as an upper respiratory tract infection, her condition worsened within one week. Cerebrospinal fluid analysis showed elevated intracranial pressure, protein, and cell counts. Next-generation sequencing and lymph node biopsy confirmed S. strictum meningitis. With the increasing use of immunosuppressants in the post-COVID-19 era, the incidence of rare fungal CNS infections may rise. Amphotericin B combined with voriconazole appears to be an effective treatment. In cases with cerebral vasculitis, adjunctive anti-vasculitis therapy may be helpful. However, the exact mechanisms remain unclear.

Meningoencephalitis and cerebral vasculitides

Sarocladium strictum

Fungal infection

Case report

© 2025 The Authors. Published by Elsevier Inc.