A 49-year-old man was admitted with altered mental status, high-grade fevers, tachycardia and leucocytosis. Cerebrospinal fluid (CSF) was purulent with a markedly elevated nucleated cell count with neutrophilic predominance, elevated protein and low glucose. CSF gram stain was negative. Patient received vancomycin, cefepime, ampicillin and acyclovir for presumed meningitis. He was intubated for protection of airway and underwent bronchoscopy. Microscopic examination of the bronchoalveolar lavage noted Strongyloides filariform larvae. Ivermectin was prescribed. Other laboratory tests showed a positive HIV test associated with a low CD4 count. Stool ova and parasite also revealed Strongyloides and repeat lumbar puncture identified larvae in the CSF. Albendazole was added for adjunctive therapy. However, the patient suffered a large intraparenchymal haemorrhage extending into the ventricles and he expired 36 days after admission.
- intensive care
- HIV / AIDS
- Tropical medicine (infectious disease)
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Contributors All authors have contributed equally to this paper.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.