Table 1.

Summary of Patient Cases

	CASE 1	CASE 2
Age	26	30
Gender	Male	Male
Significant comorbidities	–	HCV
HIV status	Negative (HIV RNA not detected)	Negative
CD4, cells (%)	474 (40%)	754 (39%)
Duration of symptoms at hospital presentation	2–3 weeks	1 month
Symptoms	Altered mental status, severe headache, seizures	Altered mental status, headaches, dizziness, blurred vision, blurry/double vision, loss of spatial judgement
Reported illicit drug use	Heroin & cocaine	Heroin
Imaging (MRI/CT)	MRI brain: worsening leptomeningeal disease with increased areas of T2 FLAIR hyperintensity and contrast enhancement involving the surfaces of the brain; large bilateral subacute anterior cerebral artery territory infarcts and an infarct in the left middle cerebral artery territory	MRI brain: multiple acute infarctions of the cerebrum, brainstem, and cerebellum, with associated pathologic enhancement, likely secondary to septic emboli from a central source; evidence of basilar predominant leptomeningitis. CTA brain: Irregular narrowing of the M1 ACA and A2 ACA suggestive of vasculitis
Initial lumbar puncture results	Opening pressure 34 mm H2O Glucose 26 mg/dL Protein 101 mg/dL RBC 6 cells/μL WBC 423 cells/μL 17% segs, 11% monocytes, 64% lymphocytes	Opening pressure not reported, EVD already in place Results reported as LP (EVD): Glucose 12 mg/dL (52 mg/dL) Protein 200 mg/dL (47 mg/dL) RBC 1 cells/μL (195 cells/μL) WBC 34 cells/μL (18 cells/μ) 63% segs, 36% lymphocytes
CSF CrAg	1:2056	>  1:2560 (LP); 1:320 (EVD)
Initial Serum CrAg	Negative	>  1:2560
Species	Cryptococcus neoformans	Cryptococcus neoformans from lumbar CSF