Dual infectious brainstem encephalitis with Aspergillus flavus and Haemophilus influenza in an immunocompetent patient
A 60-year-old female of Zimbabwean origin was admitted with 2-day history of headache, fever, and weakness in all her limbs. Her past medical history included nasal congestion for the last 6 months. On neurological examination, the patient was confused with a right-sided upper motor neuron facial nerve palsy, a right abducens palsy, and an asymmetric quadriparesis. C-reactive protein on admission was 157 mg/L. Cerebrospinal fluid (CSF) examination revealed marked polymorphic pleocytosis (1430 polymorphs and 30 lymphocytes), increased protein of 2583 mg/L, and low glucose of 2.9 mmol/L. Haemophilus species were identified on CSF culture and CSF polymerase chain reaction (PCR).
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