The document presents a case of cryptococcal meningitis in a 47-year-old female patient with symptoms including cough, fever, headache, vomiting, and slurring of speech. A series of lab results indicate severe anemia, elevated ESR, and abnormal liver function tests. The patient's medical history includes retroviral disease, with no significant past or family medical history reported.

1. CASE PRESENTATION
ON
Cryptococcal Meningitis
PRESENTED BY
AFREEN NASIR
3rd PHARM D
REG NO. 17QO902

2. PATIENT DEMOGRAPHY
SUBJECTIVE DATA
Chief complaints:
C/O cough since 1 month , fever since 15 days , headache since 4 days, vomiting since 2 days ,
slurring of speech since 2 days.
History of present illness:
• Patient was apparently well 1 month back then she developed cough gradual in onset &
progressive, along with scanty expectoration, mucoid ,non blood tinged
• Fever was intermittent during evening with chills rigor , myalgia, headache (Holocranial –
throughout day)
• H/O ↓ appetite , weight loss
• Vomiting – projectile , non bilious , contain food particle
• No H/O bleeding manifestation or chest pain
Ward: 4th FMW DOA: 06/12/19 DOD: 11/2/2020
Sex: F Unit : Med-3 Age : 47 YEARS

3. Past medical & surgical History:
Not K/C/O T2DM , HTN , TB ; No surgeries in past (tubectomy)
K/C/O retroviral disease + ,Post menopause – 2 years
Family History: Nothing significant
Medication History : Nothing significant
Social history :
Diet Mixed
Allergies Not known
Bowel & bladder Normal , Regular
Sleep ↓
Appetite ↓
Smoking tobacco products /Alcohol Never used

4. OBJECTIVE DATA
Vitals:
General Physical Examination:
• Patient is moderately built ,well nourished, conscious ,oriented to time/ place/ person
• Pallor +, Icterus , Cyanosis, Clubbing, Lymphadenopathy, Edema – Absent
Systemic examination :
BP : 140/80 mmHg Heart rate : 98 beats /min SPo2 : 96% RA Respiratory rate :30 breaths / min
HEENT : N Kernig’s sign : +
CNS : HMF (N) Brudzinski’s sigh : +
RS :B/L vesicular breath sound + Plantar :↓↓
Par abdomen : Soft Tone : N
CVS : S1 S2 + Tachycardia Power: 5/5
Neck stiffness : +

5. Lab examination: (Datewise results)
Tests performed 28/12/19 28/1/20 4/2/20 11/2/20 Normal range
Hb 10.1 ↓ 6.9 6.6 8.5 F=12.3-15.3g/dl
PCV 30.1 22.1 20.4 18.9 F=36-46%
RBC 3.56 2.54 1.94 F=3.5-4.5×10⁵ /mm³
Platelets 3.8 3.70 3.7 3.78 1.5-4.5 lakhs / mm³
MCH 27 30.0 28.4 27.5-33.2pg/cell
MCV 87 92.7 97.4 80-96 fL/cell
MCHC 31 34.49 29.1 32-36 g/dl
ESR 135↑ 1-20 mm/hr
WBC 5140 4500 5900 8670 4000-11,000 /mm³
Neutrophils 72 43 50 58 40-75%
Eosinophils 01 12 12 05 1-8%
Lymphocytes 38 33 29 28 20-45%
Basophils 00 00 00 00 ˂1%
Monocytes 09 12 10 09 2-10%
LDL 23 73 ˂130 mg/dl

6. Tests performed 28/12/19 28/1/20 4/2/20 11/2/20 Normal range
Sr . Creatinine 0.7 1.2 1.0 1.0 F=0.5-0.9
BUN 22 34 29 17 ˂50mg
Sr .Sodium 125 124 129 135 136-145mEq/L
Sr. Potassium 4.3 5.3 5.2 4.4 3.5-5.1mEq/L
Sr. Chloride 101 95 96 102 97-114mEq/L
LFT
S . Total protein 8.1 8.9 6.6-8.7 g/dL
S.Albumin 5.0 3.4 3.5-5.2 g/dl
S. Globulin 0.6 5.5 2.5-4.5g/dl
ALT/SGPT 19 52 F=˂33 U/L
AST/SGOT 12 36 F=10-35U/L
ALP-alkaline phosphatase 130 F=35-104 U/L
Total bilirubin 0.75 1.3 Upto1.2mg/dl
Direct bilirubin 0.30 0.5 0.2mg/dl