A 32-year-old male, ex-addict to parenteral drugs (PAD), HIV negative three years earlier, presented with occipital headache, fever and back pain of 24 h onset.
She also reported diarrhea and abdominal pain that disappeared spontaneously one week before admission.
She had no other relevant history and did not undergo any treatment.
Physical examination revealed a muguet, an axillary temperature of 39° and neck stiffness without neurological focus.
Blood count, blood biochemistry, systematic urine test, chest X-ray and cerebral computerized axial tomography were normal or showed invaluable alterations.
Lumbar puncture showed 2000 cells per mm3 (80% polymorphonuclear), 38 mg% glucose (plasma 99 mg%) and 1.40 g/dL proteins.
Although initially she was not diagnosed with HIV infection, she was diagnosed with muguet.
It was confirmed by ELISA and Western-blot and CD4+ lymphocyte count was 364 per mm3 (14%).
The clinical picture was interpreted as meningitis, probably bacterial, and treatment with ampicillin and cefoxime both administered intravenously was initiated.
Cerebrospinal fluid culture grew Lis.
Cefuroxime was synthesized by tobramycin after identifying the responsible agent.
After 7 days of therapy severe drug eruption appeared that conditioned the withdrawal of medication.
Both antibiotics were suspended starting treatment with cotrimoxazole until completing 4 weeks.
The evolution was favorable.
Table I shows the evolution of cerebrospinal fluid parameters during treatment.
