A 40-year old man with a prior history of partial craniotomy and alcohol abuse was admitted to the hospital with headache, fever, neck pain, and weight loss over the previous two weeks. The patient had a history of a flu-like illness preceded by non-bloody diarrhea, but these symptoms had settled several days prior to admission. On admission, he was febrile to 39.4 O C. He flexed his neck with difficulty, and Kernig’s and Brudzinski’s tests were positive.
Neurological exam demonstrated normal functioning except for marked confusion. Laboratory data showed serum WBC 15,000/mm 3 with a left shift Cerebrospinal fluid analysis showed WBC- 543 WBC/mm 3 with 85% neutrophils and 15% lymphocytes Glucose- 24 mg/dl Protein- 117 mg/dl The fluid was negative for India ink, cryptococcal antigen and acid-fast. The initial treatment included intravenous administration of vancomycin and ceftriaxone. On…
