notesonly.in

A 38-year-old male presents to the outpatient clinic complaining of severe headache, fever, neck stiffness, and painful white patches in his mouth for 10 days. On physical examination, he has positive Kernig and Brudzinski signs (indicating meningeal irritation or brain lining inflammation). Oral examination reveals white curd-like plaques on the tongue (oral candidiasis). His CD4+ T-cell count is severely low at 45 cells/microliter (normal: 500-1500 cells/microliter), confirming advanced HIV infection (AIDS stage). Lumbar puncture (spinal fluid extraction) and India Ink staining confirm Cryptococcus neoformans (fungal brain infection). Diagnostic reasoning: The patient has severe opportunistic infections (oral thrush and cryptococcal meningitis) secondary to profound immunosuppression from untreated HIV. Management plan: 1. Induction therapy for meningitis with intravenous Liposomal Amphotericin B plus oral Flucytosine for 2 weeks, followed by consolidation with oral Fluconazole. 2. Antiretroviral therapy (ART) with TLD regimen (Tenofovir + Lamivudine + Dolutegravir) initiated 2 weeks after starting antifungal treatment to avoid IRIS (Immune Reconstitution Inflammatory Syndrome, a dangerous hyper-inflammatory reaction).