A 45-year-old female patient presented with fever, confusion, nuchal rigidity, and vomiting to the emergency department of our hospital. She had a runny nose for the three days prior to admission and frontal headache. Her past medical history was significant for hypertension and allergy to penicillin. The patient was on nifedipine, monoxidine, and irbesartan per os. On examination, she was febrile with a temperature of 38.3 0 C. Her blood pressure was 140/90 mmHg, pulse 100 per minute regular and 14 respirations per minute. She was confused and stuporose.
A computed tomography of the brain was normal. Subsequently, she underwent a lumbar puncture. Examination of the cerebrospinal fluid revealed 550 cells/mm3, 78% lymphocytes, 56 mg/dl glucose levels (serum glucose levels: 111 mg/dl), protein 111,8 mg/dl. Gram stain of the cerebrospinal fluid (CSF) was negative, as was culture of the CSF.