Answer: C-Candida Meningitis. Severe hypoglycorrhachia occurs in the setting of subarachnoid hemorrhage, glucose transport defects, infectious meningitis, meningeal carcinomatosis, inflammatory, and autoimmune conditions. Candida’s morphology (small unicellular yeast) allows its spread through the blood–brain barrier into the subarachnoid space and meninges, unlike dimorphic and hyphae organisms. It may present with cerebral micro or macro-abscesses, meningitis, and vascular complications. Our patient’s MRI pattern of nodular pachymeningeal (gray arrow), and leptomeningeal (white arrow) enhancement, along with micro-abscesses (black arrow); and hypoglycorrhachia, and history of active intravenous heroin use suggested a yeast fungal infection [[1]Mathur M. Johnson C.E. Sze G. Fungal infections of the central nervous system.Neuroimag Clin North America. 2012; 22: 609-632Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar]. Specific antifungal therapy was added to the empirical antibiotic coverage initiated in the emergency room, with rapid clinical improvement. Subsequently, CSF smear identified Candida Albicans 12 h after admission. CSF cultures confirmed the diagnosis. An expedient identification of fungal central nervous system infections is critical to minimize their progression and control life-threatening complications (i.e. seizure, stroke, and hydrocephalus) [[2]Sanchez-Portocarrero J. Perez-Cecilia E. Corral O. et al.The central nervous system and infection by Candida species.Diagn Microbiol Infect Dis. 2000; 37: 169-179Abstract Full Text Full Text PDF PubMed Scopus (146) Google Scholar] (Fig. 1). No financial disclosure to report. Basic principles unveil an unusual diagnosisJournal of Clinical NeuroscienceVol. 42PreviewA 59 year-old man with medical history significant for current intravenous heroin abuse presented with status epilepticus. Cerebrospinal fluid (CSF) showed 317 neutrophils, 45 red blood cells, lactate 6.7 mm/L, protein 140 md/dl, and glucose 24 mg/dl. Glucose CSF/serum ratio was 0.14. Opening pressure was 23 cm of water. Cytology studies and HIV were negative. MRI was performed, illustrated in the figure. What is the most likely diagnosis? Full-Text PDF