23rd May 2024

A 54-year-old man with a background of diabetes and non-alcoholic fatty liver disease

A 54-year-old man with a background of diabetes and non-alcoholic fatty liver disease presents with a 6-day history of fever, headache and photophobia. On examination, you elicit nuchal rigidity, a 7th cranial nerve palsy and a GCS 13/15. Chest and abdomen examination appear normal. Paramedics mentioned that he had a seizure lasting 2 mins in the ambulance. A CT head shows early changes of hydrocephalus. Bloods show a Haemoglobin of 13 g/L, WCC: 17 x10⁹/L and neutrophils: 13x 10⁹/L. The remainder of bloods are largely unremarkable other than an ALT of 300.

What is the most likely finding on blood culture and lumbar puncture?

Select the SINGLE most appropriate option from the list below. Select ONE option only.