A 34-year-old man with HIV infection presents to the emergency department with a 2-week history of fever, progressive headache, and neck stiffness. He has not taken antiretroviral therapy for 6 months. Vital signs are notable for temperature 39.2°C, blood pressure 110/68 mmHg, heart rate 102/min, and respiratory rate 18/min. Physical examination reveals nuchal rigidity but no focal neurologic deficits or rash. Laboratory studies show CD4 count of 18 cells/μL and serum cryptococcal antigen positive. Lumbar puncture is performed with cerebrospinal fluid (CSF) analysis revealing: protein 180 mg/dL, glucose 28 mg/dL, opening pressure 32 cm H2O, and white blood cell count 50/μL (mostly lymphocytes). India ink preparation of the CSF demonstrates round, encapsulated yeast. Which of the following is the most likely diagnosis?
- A)Tuberculous meningitis with CSF tuberculostasis
- B)Toxoplasmic encephalitis with secondary meningitis
- C)Cryptococcal meningitisGABARITO
- D)Bacterial meningitis caused by Listeria monocytogenes
- E)Coccidioidal meningitis with pulmonary involvement
Explicação
Cryptococcal meningitis is the most likely diagnosis. This patient presents with classic features: severe immunosuppression (CD4 <50 cells/μL), subacute meningitis (2-week course), CSF hypoglycorrhachia (glucose 28 mg/dL with normal serum glucose implied), ele... Ver explicação completa e trilha adaptativa →