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Table 1 Summary of Patient Cases

From: Cryptococcus meningitis mimicking cerebral septic emboli, a case report series demonstrating injection drug use as a risk factor for development of disseminated disease

 CASE 1CASE 2
Age2630
GenderMaleMale
Significant comorbiditiesHCV
HIV statusNegative (HIV RNA not detected)Negative
CD4, cells (%)474 (40%)754 (39%)
Duration of symptoms at hospital presentation2–3 weeks1 month
SymptomsAltered mental status, severe headache, seizuresAltered mental status, headaches, dizziness, blurred vision, blurry/double vision, loss of spatial judgement
Reported illicit drug useHeroin & cocaineHeroin
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 territoryMRI 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 resultsOpening 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 CrAg1:2056>  1:2560 (LP); 1:320 (EVD)
Initial Serum CrAgNegative>  1:2560
SpeciesCryptococcus neoformansCryptococcus neoformans from lumbar CSF