PMC3335363_01
Non-contrast MRI of the patient's brain shows slight atrophy, ventricular enlargement and cerebral microangiopathy.
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F1
However, they revealed brain atrophy, an internal hydrocephalus and relevant cerebral microangiopathy (fig. 1).
Time course of leukocyte cell counts in CSF (a) and serum (b). The arbors illustrate the time interval of antibiotic therapy. Note the intermittent effect after fosfomycin therapy.
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F2
CSF again showed a high cell count of 1,080/mm3, with 31% neutrophils and 56% lymphocytes (fig. 2a), low glucose (48 mg/dl, with serum glucose 180 mg/dl), high protein content (339 mg/dl), and high lactate [.1 mmol/l (reference value 1.2-2.1)]. CSF pressure was elevated to 25 cm H2O. On the fifth day, he developed Lyell's syndrome with a generalized rash and bullous exanthema leading to allergic shock which had to be treated with catecholamines (time course of C-reactive protein (CRP) and leukocyte cell count data in serum, fig. 2b). Within 14 days, the CSF leukocyte cell count dropped to 68/mm3 as revealed by a lymphocytic cell picture, and the protein content fell to 55.9 mg/dl; CRP and serum white cell count decreased to reference values (fig. 2b).