A 52 year old female with congenital asplenia presented to the emergency department with altered mental status, difficulty communicating, and neck pain. This had been preceeded by three days of right ear fullness and malaise. A lumber puncture was performed, significant for an opening pressure of >50 cm H2O, 20,565 nucleated cells/µl with neutrophil predominance, glucose 1250 mg/dL. Gram stain of the cerebrospinal fluidis shown (Figure).
|Kyle Rodino, Ph.D.
Fellow, Clinical Microbiology