A 53-year-old man presented with fever, headache, and neck pain for 7 days. Brain computed tomography (CT) done from outside facility was noncontributory. A lumbar puncture was done, and cerebrospinal fluid (CSF) was uniformly hemorrhagic. After correcting for red blood cells, his CSF still had an elevated white blood cell (WBC) count (neutrophilic predominance) and protein level, with a CSF to serum glucose ratio of <0.4. The CSF was negative for tuberculosis and multiplex polymerase chain reaction (PCR) based common pathogens. He was hemodynamically stable. The WBC and C-reactive proteins were marginally elevated. Intravenous ceftriaxone and vancomycin started.
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