CSF India Printer ink preparation and latex agglutination test for cryptoccocus was positive (1:16 dilution). HIV test. The management issues, in addition to antifungal therapy, include nutritional supplements for the protein losing enteropathy. strong class=”kwd-title” Keywords: Cryptoccocal meningitis, cellular and humoral Caffeic Acid Phenethyl Ester immunity, intestinal lymphangiectasia Intro Main intestinal lymphangiectasia (PIL) is definitely a rare disorder characterized by dilated intestinal lacteals, resulting in lymph leakage into the lumen of the small bowel, and is responsible for protein-losing enteropathy, leading to lymphopenia, hypoalbuminemia and hypogammaglobulinemia.[1] Although PIL patients have moderate to severe hypogammaglobulinemia and lymphopenia, their risk of contracting a pyogenic bacterial infection is not significantly elevated, and opportunistic infections are uncommon. Only one case of a severe illness with group G streptococcal empyema was reported,[2] and another experienced cryptococcal meningitis.[3] With this report, we describe Caffeic Acid Phenethyl Ester the event of cryptoccocal meningitis in an adult as the primary manifestation of PIL. Case Statement A 30-year-old female (excess weight 46 kg) offered to our division with severe headache since the last 7 weeks. Her past history was unremarkable. On general physical exam, there was moderate pallor with slight pedal edema. Neurological exam revealed bilateral papilledema. There were no focal neurological deficits and meningeal indications were absent. The patient was admitted and investigated to evaluate the cause of raised intracranial pressure. Magnetic resonance imaging (MRI)Mind Plain and Contrast Study showed slight meningeal enhancement with normal venogram. Cerebrospinal fluid (CSF) was under high pressure (280 mm of water) with 30 cells (80% lymphocytes and 20% neutrophils), protein was 53 mg%, glucose was 12 mg% and chlorides were 125 mg%. CSF India Ink preparation and latex agglutination test for cryptoccocus was positive NIK (1:16 dilution). CSF ethnicities (fungal) showed growth of em Cryptoccocus neoformans /em . Program hematological investigations exposed moderate Caffeic Acid Phenethyl Ester anemia and lymphocytopenia (Hb 6.6 gm/dl, total WBC count 9100 cells/mm3 with polymorphs 95%, lymphocytes 5% and ESR 2 mm/1st hr). Peripheral smear showed microcytic hypochromic anemia with lymphopenia. As the lymphocyte count was low on two occasions, absolute CD4 count was carried out and was found to be very low at 44 cells/l (normal 354C1100 cells/l). Checks for human being immunodeficiency disease (HIV) with enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) were negative. At the same time, we found that her total serum protein was 3.4 gm%, with albumin 1.5 gm%. Renal guidelines, serum bilurubin and liver enzymes were normal. There was no evidence of proteinuria. Ultrasound of chest and belly showed slight bilateral pleural effusions and ascitis with normal liver and kidneys. As the patient experienced low protein we also assessed the levels of numerous serum globulins. Serum immunoglobulins were low IgG-793 (normal 800C1700 mg/dl), IgA-126 (100C490 mg/dl) and IgM-38 gm/L (50C320 mg/dl). Serum ceruloplasmin was 14.7 mg/dl (normal 13C36 mg/dl). On iron studies, even though serum iron was low at 8.0 mg/dl (normal Caffeic Acid Phenethyl Ester 49C151 mg/dl), total iron binding capacity was 241 mcg/dl (normal 250C400 mcg/dl), indicating low serum transferrin levels. On further investigations, Caffeic Acid Phenethyl Ester the lipid profile showed total cholesterol of 129 mg/dl (normal range 160C200), low-density lipoprotein cholesterol 86 mg/dl (normal range 100C129 mg/dl), very low-density lipoprotein cholesterol 13 mg/dl (normal range 5C40 mg//dl) and Triglycerides 65 mg/dl (normal 150 mg/dl), suggestive of hypocholesterolemia. We started investigating the patient for causes of a combination of protein losing enteropathy, hypocholesterolemia and lymphopenia. Stool exam for giardiasis was bad. A analysis of intestinal lymphangiectasia was suspected in view of deficient humoral and cellular immunity with low albumin. The patient was subjected to top gastrointestinal (GI) endoscopy, which showed a whitish granular appearance of mucosa in the duodenum with white-tipped villi, spread white spots, white nodules and submucosal.