12th August 2024

A 58-year-old man presents with a 2 week history of headache, fevers and lethargy

A 58-year-old man presents with a 2 week history of headache, fevers and lethargy. He was diagnosed with HIV 18 years ago, however he is not compliant with his treatment regime and hasn’t attended a clinic appointment in 2 years. He owns a cafe and works full time. His most recent CD4 count is 89 cells/microL. On examination, he is noted to be slightly confused with an AMTS (abbreviated mental test score) of 7/10. His CT brain is normal. CSF results are as follows: opening pressure 27 cmH₂O, WBC 25/mm³ (predominantly mononuclear cells), protein 0.80 g/L, glucose 2.8 mmol/L. CSF India ink stain shows encapsulated yeast organisms.

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