PathWays Case Study: Aug. 23
A patient with recent ventriculoperitoneal (VP) shunt placement presented with vertigo, headaches, and vomiting. Chest CT was consistent with prior granulomatous infection. Cerebrospinal fluid (CSF) analysis demonstrated elevated protein, normal glucose, and 58 nucleated cells (86% mononuclear). Histoplasma serology was ordered. Serum and CSF immunodiffusion was positive for H and M-bands (Figure 1, C). Serum and CSF complement fixation titers were 1:32 and 1:64 for yeast antigen and 1:16 and 1:128 for mycelial antigen, respectively (representative complement fixation on patient serum, Figure 2, E). CSF fungal cultures and a Histoplasma urine antigen test were negative.
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Rachael Liesman, Ph.D.
Resident, Clinical Microbiology
Mayo Clinic
Instructor in Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine
Elitza Theel, Ph.D.
Consultant, Division of Clinical Microbiology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine