Cryptococcal meningitis associated with increased adenosine deaminase in the cerebrospinal fluid Tanaka and Satomi SpringerPlus (2016) 5 2093 DOI 10 1186/s40064 016 3767 z CASE STUDY Cryptococcal meni[.]
Tanaka and Satomi SpringerPlus (2016)5:2093 DOI 10.1186/s40064-016-3767-z Open Access CASE STUDY Cryptococcal meningitis associated with increased adenosine deaminase in the cerebrospinal fluid Yuji Tanaka* and Kazuo Satomi Abstract Introduction: Clinically, increased cerebrospinal fluid (CSF) adenosine deaminase (ADA) level is an important diagnostic clue of tuberculous meningitis However, increased CSF ADA level can be caused by other neurological diseases Case description: We report a case of a 67-year-old woman with cryptococcal meningitis presented with increased ADA level of the CSF In parallel with her recovery, the ADA level of CSF decreased steadily This is the first case described the chronological change in CSF ADA level of the patient with cryptococcal meningitis in detail Discussion and Evaluation: Clinically, increased CSF ADA level is an important diagnostic clue of tuberculous meningitis However, previously, it was reported that increased CSF ADA level can be caused by other neurological diseases In this case, the patient was diagnosed with cryptococcal meningitis, and the possibility of coinfection with tuberculous meningitis has been discarded by the negative PCR, negative cultures and the clinical course In addition, the chronological change in CSF ADA level was useful for follow-up assessment Conclusions: Cryptococcal meningitis should be considered for the differential diagnosis for diseases presented increased CSF ADA Keywords: Cryptococcal meningitis, Adenosine deaminase, Cerebrospinal fluid, Follow up, Differential diagnosis Introduction Clinically, increased cerebrospinal fluid (CSF) adenosine deaminase (ADA) level is an important diagnostic clue of tuberculous meningitis (TBM) However, increased CSF ADA level can be caused by other neurological diseases We report of an older patient with cryptococcal meningitis associated with increased CSF ADA level, in which information on the chronological change in ADA level was useful for follow-up assessment Case description A 67-year-old woman was diagnosed with hypertension at age 30 years Her family had no history of active tuberculosis, but the patient had bred a hill myna Three months *Correspondence: yutanaka‑gif@umin.net Department of Neurology, Gifu Municipal Hospital, 7‑1 Kashima‑Cho, Gifu City 500‑8513, Japan before admission to the hospital, the patient initially developed a slight fever and headache After 3 months, the patient could not walk independently and her level of consciousness declined, for which the patient was admitted to our hospital A neurological examination revealed reduced consciousness (Glasgow coma scale; E3 V3 M5) and meningeal irritation, hyperreflexia of all four-extremities, and positive Babinski response Blood examination revealed normal findings, including inflammatory reactions, and negative results for human immunodeficiency virus antibody In the CSF examination, the cell count was 46/µL (all lymphocytes); the protein level, 142 mg/dL (reference range 10–40 mg/dL); glucose level, 31 mg/dL (reference range 50–75 mg/dL); and ADA level, increased to 12.7 U/L (reference range