Abstract
Introduction: A 41‐year‐old man with a history of alcoholic cirrhosis presented to Patan Hospital in Kathmandu, Nepal, with a severe headache. Case presentation: Clinical examination found an isolated sixth nerve palsy of the left side with normal blood parameters and a normal brain scan. An initial cerebrospinal fluid analysis found lymphocytosis, with a significantly elevated protein level and reduced glucose. Tubercular meningitis was considered; however, the patient did not improve and a re‐examination of the cerebrospinal fluid confirmed cryptococcal meningitis. Conclusion: After diagnosis the patient was treated with amphotericin B. Despite all efforts the patient died 5 days later.
Highlights
IntroductionA 41-year-old man with a history of alcoholic cirrhosis presented to Patan Hospital in Kathmandu, Nepal, with a severe headache
A 41-year-old man with a history of alcoholic cirrhosis presented to Patan Hospital in Kathmandu, Nepal, with a severe headache.Case presentation: Clinical examination found an isolated sixth nerve palsy of the left side with normal blood parameters and a normal brain scan
The prolonged consumption of alcohol for more than 20 years led to alcoholic cirrhosis, which was diagnosed when he had bleeding oesophageal varices
Summary
Cryptococcal meningitis is the most common clinical syndrome due to infection with the encapsulated yeast Cryptococcus neoformans. On physical examination there was no evidence suggesting complications of cirrhosis and the patient was alert and well oriented as to time, place and person. His vital signs were within the normal range and recorded as: temperature 98 uF, pulse 78 min, respiratory rate 18 min and blood pressure 130/90 mmHg. A neurological examination revealed left sixth nerve palsy, and there. The CSF analysis revealed 250 white blood cells ml with 26 % neutrophils and 74 % lymphocytes, protein 59 mg dl, and glucose 44 mg dl (blood glucose level 128 mg dl21) with persistent yeast cells on Gram staining. The patient died 2 days later due to suspected respiratory failure
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