Cryptococcus neoformans Meningoencephalitis- The opening pressure on lumbar puncture was 29 cm of water (reference range, <20 cm). The cerebrospinal fluid (CSF) cell count was 340 cells per microliter (reference range, 0 to 10), with 90% mononuclear cells, which were predominantly lymphocytes. The glucose level was 46 mg per deciliter (2.6 mmol per liter; reference range, 40 to 70 mg per deciliter [2.2 to 3.8 mmol per liter]), and the protein level was 0.80 g per liter (reference range, 0.15 to 0.45). Gram’s stain (Panel A) and India ink stain (Panel B) revealed abundant encapsulated, round yeasts, with some budding forms. The cryptococcal antigen titer was 1:128, and the CSF culture grew Cryptococcus neoformans. No other pathogen was detected. A test for the human immunodeficiency virus antibody was positive; the viral load was 300,000 copies per milliliter, and the CD4+ count was 7 cells per microliter (reference range, 500 to 1450). #clinical #NEJM #Cryptococcus #neoformans #meningoencephalitis #gram #stain #indiaInk #pathology
