Adhiambo is a 30 year-old woman brought to the clinic by her husband.

She was well until the day before. Now she complains of: Fever and headache. Her husband says she's been 'acting strangely'. She has a history of tuberculosis 2 years ago, but otherwise is no significant past history. She is a thin woman, confused and lethargic.

©www.KarlGrobl.com

Physical Exam:

• Vital signs: Temp = 38.7°C, Pulse = 100, BP = 100/60, Resp = 24.
• When her neck is flexed, her entire back arches off the examining table.
• There are no focal neurological deficits, no JVD and no neck adenopathy.
• She has oral thrush.
• Her lungs are clear and there are no cardiac abnormalities to auscultation.
• Blood smear is negative for parasites.

An LP is done and she is admitted on chloramphenicol, Haldol and quinine.

The following morning Adhiambo is seen on rounds.