Naseem Salahuddin, Farheen Ali, Faisal Sultan, Sharaf Ali Shah.
It appears to be AIDS, but is it?.
Infect Dis J Jan ;13(3):78-81.

A 32 year old male with a history of Type 2 diabetes and chronic liver disease secondary to hepatitis C virus, presented with two weeks of fever and headache. He was diagnosed with “tuberculous meningitis” based on cerebrospinal fluid (CSF) chemistries and cell counts. He was started on standard first line anti-tuberculous therapy with oral steroids (prednisolone 30mg/day) and initially did well and was discharged. A week later he again developed headache, now with vomiting and generalized abdominal pain. He had lost an unspecified amount of weight and had fever and oral ulcers. The patient was a farmer, belonged to Sind, and had never traveled out of the country. He gave a history of alcohol consumption almost daily for over 10 years and admitted to homo- and heterosexuality. He had no exposure to tuberculosis. On examination, he was a thin, and his oropharynx was erythematous and covered with white plaques of yeast. There was minimal ascites but no palpable organomegaly. Because of the fever, headache and oropharyngeal candidiasis and a tenuous diagnosis of TB meningitis, lumbar puncture was repeated at this hospital. CSF chemistries showed glucose of 14 mg%, (concomitant blood sugar was 210 mg%), protein of 72 mg% (ref. range 25 – 45), red blood cells of 100 /mm3 and white blood cells 5/mm3 . India ink stain showed a profusion of encapsulated budding yeast and culture grew Cryptococcus neoformans. The Cryptococcal antigen was 1:8 in the CSF. Antibodies to HIV I and II were negative by ELISA twice and by Western Blot. All three tests were done because of the strong clinical possibility of HIV/AIDS.

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