Faria Malik, Abida Iqbal.
Cryptococcus Meningitis.
Infect Dis J Nov ;14(1):21.

In July 2002, a 25 year old goldsmith, present with an altered state of consciousness and vomiting. He had high grade fever and headache for the past 2 months. On general physical examination, the patient appeared dehydrated and pale. He was disoriented. Subsequently, the GCS decreased to 11/15. Neck stiffness and Kerning`s sign were positive. A provisional diagnosis of tuberculous meningitis was made and the patient was started on anti-tuberculous therapy with cephalosporins and steroids. His labs showed: Haemoglobin was 12 gms/dl, total leukocyte count was 10,200/cumm with 70% polymorphonuclear leukocytes, 25% lymphocytes, 3% monocytes and 2% eosinophils. ESR was 110 mm in 1st hour. blood culture yielded no growth. The patient was HIV negative. X-ray chest revealed two cavities in the upper and mid zones of the right lung. The CSF was slightly turbid to the naked eye and without a web or clot. The CSF white cell count was 1000/cumm.; RBCs were 80/ cu mm. The Gram stain showed large oval gram positive cells, which prompted examination of India ink preparation of the sediment and a diagnosis of Cryptococcal meningitis was made. The sediment was cultured onto Sabouraud`s agar and subsequently grew Cryptococcus neoformans . Despite treatment, the patient developed decerebrate rigidity, loss of brainstem reflexes and expired a month after presentation.

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