Diagnosis made in medical mystery

FARGO - When Cori Scott was rushed to Fargo's Innovis Health on a January night, she didn't recognize her mother and fought the staff. Caught in four-point restraints, she slipped into a comatose state.

FARGO - When Cori Scott was rushed to Fargo's Innovis Health on a January night, she didn't recognize her mother and fought the staff. Caught in four-point restraints, she slipped into a comatose state.

The nightmarish admission followed half a dozen area hospital visits since a September trip to California's St. Joaquin Valley. Each time, doctors failed to figure out why the 37-year-old Fargo native's health steadily deteriorated.

In the following days, Innovis neurologist Roberto Patron raced to diagnose Scott's mysterious illness. Family members had flocked to the Innovis intensive care unit from both coasts, and their hope fueled his resolve, even as his team broached the prospect of pulling Scott off life support.

"She was much closer to being dead than being alive," Patron said. "But the key here is that nobody wanted to give up."

Baffling symptoms


Patron first met Scott in October, when she spent a week at Innovis recovering from pneumonia.

But soon after Scott returned home to Lake Park, Minn., the debilitating headaches began. A CT scan in Detroit Lakes didn't show anything unusual, and doctors sent her home with pain meds.

To Scott's friends, it was evident she wasn't quite herself. Outgoing and feisty, she had juggled two jobs last summer to keep up with her mortgage payments. Her social circle's resident comedienne, she could score a laugh with her perfectly timed, skeptical eyebrow lift.

Now, she stayed in her room for days, listless.

On Jan. 11, when Cori had trouble lifting her head from her pillow, her friends drove her to the ER in Perham, Minn. A few hours later, they left without a diagnosis.

Scott's friends carried her back to the car and drove to the ER in Detroit Lakes, Minn. During the ride, she shook her head and spoke gibberish, until, says friend Rita Alaniz, "Cori wasn't Cori anymore."

In Detroit Lakes, doctors had Scott rushed to Innovis by ambulance.

"When she got here, she didn't even know who I was," said her mom, Trudy Dura.


The next morning, Patron found Scott unresponsive and barely clinging to life. At the time, he didn't know that in September, Scott had traveled to Fresno, Calif., for a cousin's wedding. Nobody thought to bring that up.

Then, the lab technician working on Scott's spinal tap culture found traces of a fungus. The team was about to dismiss the rare find as contamination.

"Fungal infections are usually horrible infections," Patron said. "When you get a result of fungus in the brain, your heart stops for a few seconds."

But he was suspicious, so he arranged to have Scott's spinal tap culture tested at the Mayo Clinic in Rochester, Minn. Days later, he got a call back: Scott had coccidioidomycosis, or valley fever.

The fungi that cause this infection grow in the desert soils of California's St. Joaquin Valley and southern Arizona. When farming or wind disrupts the soil, their spores can be inhaled. Most of the roughly 100,000 people infected annually experience flu-like symptoms. In some cases, the infection can spread to the lungs or skin. In less than 1 percent of infections, it can travel to the brain.

The diagnosis was bad news, said Patron: "When you review the literature of fungus in the brain, everything you get back says, 'Dead. Dead. Dead.' "

'She's a fighter'

Still, Patron decided to go all-out. Staff installed a port through which anti-fungal medication flowed directly to Scott's brain.


Scott's family kept constant vigil at the hospital.

"They were never upset," he said. "They were never in a fighting mood. They were in a healing mood."

By mid-February, Scott's relatives swore they saw her move. Patron dismissed the sightings - until he saw his patient follow him across the room with her eyes. One day, when a nurse entered, Scott said weakly, "What's up?"

Gradually, family and friends started seeing glimpses of the feisty, wry Scott they know. Her mom, who had been putting in 12-hour days at the hospital, told her one night, "I'll be here early in the morning."

"I really doubt it," said Scott, giving her mom the signature eyebrow lift.

Last week, with the help of a walker and a couple of hospital staff members, Scott took her first steps.

Friends have rallied in support. They are organizing a dinner, dance and live auction. Scott's former employer, Detroit Lakes-based Sunrise Machine and Tool, donated a wheelchair.

After almost two months at Innovis, Scott moved to Fargo's Villa Maria, a long-term care facility, earlier this week. Patron thinks she might continue to improve.


"She still has a long row to hoe," said Dura, Scott's mom. "But she's a fighter. She'll pull through."

Valley fever facts

* Valley fever is an infection caused by airborne fungal spores in California's St. Joaquin Valley and southern Arizona.

* There's little residents or visitors to these areas can do by way of prevention beyond common-sense precautions, such as staying inside during dust storms and avoiding activities that disrupt the soil, such as gardening.

* Pregnant women, smokers, people with weakened immune systems and those of Asian, Hispanic and African descent are more susceptible to valley fever complications.

* Seek medical help if you've traveled to endemic areas and experience symptoms such as fever, cough, chest pains, shortness of breath and fatigue.

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