A 28-year-old woman with low-grade fever and evening sweats for 6 weeks develops headache and vomiting. CSF examination shows 120 lymphocytes per mm3, protein 350 mg/dL with a cobweb-like coagulum on standing, and glucose 30 mg/dL (simultaneous blood glucose 110 mg/dL). CSF pressure is elevated. The most likely diagnosis is:

• A Viral meningoencephalitis
• B Cryptococcal meningitis
• C Partially treated pyogenic meningitis
• D Tuberculous meningitis ✓

Explanation

Chronic lymphocytic meningitis with markedly raised protein, low glucose, and the cobweb clot formed by fibrin precipitation is characteristic of tuberculous meningitis, reflecting exudates concentrated at the basal cisterns. Cryptococcal meningitis also gives lymphocytic pleocytosis with low glucose but typically occurs in immunocompromised hosts and does not produce a cobweb coagulum; India ink or CrAg testing distinguishes it.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.