Table 1 Summary of Patient Cases
| Â | CASE 1 | CASE 2 |
|---|---|---|
Age | 26 | 30 |
Gender | Male | Male |
Significant comorbidities | – | HCV |
HIV status | Negative (HIV RNA not detected) | Negative |
CD4, cells (%) | 474 (40%) | 754 (39%) |
Duration of symptoms at hospital presentation | 2–3 weeks | 1 month |
Symptoms | Altered mental status, severe headache, seizures | Altered mental status, headaches, dizziness, blurred vision, blurry/double vision, loss of spatial judgement |
Reported illicit drug use | Heroin & cocaine | Heroin |
Imaging (MRI/CT) | MRI brain: worsening leptomeningeal disease with increased areas of T2 FLAIR hyperintensity and contrast enhancement involving the surfaces of the brain; large bilateral subacute anterior cerebral artery territory infarcts and an infarct in the left middle cerebral artery territory | MRI brain: multiple acute infarctions of the cerebrum, brainstem, and cerebellum, with associated pathologic enhancement, likely secondary to septic emboli from a central source; evidence of basilar predominant leptomeningitis. CTA brain: Irregular narrowing of the M1 ACA and A2 ACA suggestive of vasculitis |
Initial lumbar puncture results | Opening pressure 34 mm H2O Glucose 26 mg/dL Protein 101 mg/dL RBC 6 cells/μL WBC 423 cells/μL 17% segs, 11% monocytes, 64% lymphocytes | Opening pressure not reported, EVD already in place Results reported as LP (EVD): Glucose 12 mg/dL (52 mg/dL) Protein 200 mg/dL (47 mg/dL) RBC 1 cells/μL (195 cells/μL) WBC 34 cells/μL (18 cells/μ) 63% segs, 36% lymphocytes |
CSF CrAg | 1:2056 | >  1:2560 (LP); 1:320 (EVD) |
Initial Serum CrAg | Negative | >  1:2560 |
Species | Cryptococcus neoformans | Cryptococcus neoformans from lumbar CSF |