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IMAGESINCLINICALMEDICINECryptococcusneoformansMeningoencephalitisRaulRecio,andAnaPerez-AyalaNEnglJMed;:DOI:10./NEJMicmA36-year-oldmanpresentedtotheemergencydepartmentwitha2-weekhistoryoffever,headache,drowsiness,andphotophobia.Hewaspreviouslyhealthyandwassexuallyactivewithmen.Thephysicalexaminationwasnotableforatemperatureof38.3°Candneckstiffness.Computedtomographyoftheheadwasnormal.Theopeningpressureonlumbarpuncturewas29cmofwater(referencerange,20cm).Thecerebrospinalfluid(CSF)cellcountwascellspermicroliter(referencerange,0to10),with90%mononuclearcells,whichwerepredominantlylymphocytes.Theglucoselevelwas46mgperdeciliter(2.6mmolperliter;referencerange,40to70mgperdeciliter[2.2to3.8mmolperliter]),andtheproteinlevelwas0.80gperliter(referencerange,0.15to0.45).Gram’sstain(PanelA)andIndiainkstain(PanelB)revealedabundantencapsulated,roundyeasts,withsomebuddingforms.Thecryptococcalantigentiterwas1:,andtheCSFculturegrewCryptococcusneoformans.Nootherpathogenwasdetected.Atestforthehumanimmunodeficiencyvirusantibodywaspositive;theviralloadwas,copiespermilliliter,andtheCD4+countwas7cellspermicroliter(referencerange,to).InductiontherapywithliposomalamphotericinBandflucytosinewasstarted,andresolutionofsymptomsandnegativeresultsonCSFculturewerenotedafter2weeksoftreatment.Consolidationtherapywithfluconazolewasstarted,andantiretroviraltherapywaslaterprescribed.
一名36岁男性患者因发热、头痛、嗜睡及畏光2周到急诊科就诊。患者既往健康，是同性恋患者。体格检查发现，体温38.3°C，颈项强直。头颅CT正常。腰穿初压29cmH2O（正常值20cm）。脑脊液(CSF)细胞计数/ml（正常值0to10），单核90%，主要为淋巴细胞。糖46mg/dl（2.6mmol/L；正常值40to70mg/dl[2.2to3.8mmol/L]），蛋白0.80g/L（正常值0.15to0.45）。革兰染色（图A）及墨汁染色（图B）显示大量有包膜的圆形酵母菌，部分成出芽状。隐球菌抗原滴度1:，CSF培养分离到新型隐球菌。未发现其他致病微生物。HIV抗体检测结果阳性；病毒载量,拷贝/ml，CD4细胞计数7/ml（正常值to）。开始进行脂质体两性霉素B和氟胞嘧啶的诱导治疗，2周后临床症状消失，CSF培养转阴。随后进行氟胞嘧啶的巩固治疗，并进行抗逆转录病毒治疗。
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