PathWays Case Study: Aug. 23

A patient with recent ventriculoperitoneal (VP) shunt placement presented with vertigo, headaches, and vomiting. Chest CT was consistent with prior granulomatous infection. Cerebrospinal fluid (CSF) analysis demonstrated elevated protein, normal glucose, and 58 nucleated cells (86% mononuclear). Histoplasma serology was ordered. Serum and CSF immunodiffusion was positive for H and M-bands (Figure 1, C). Serum and CSF complement fixation titers were 1:32 and 1:64 for yeast antigen and 1:16 and 1:128 for mycelial antigen, respectively (representative complement fixation on patient serum, Figure 2, E). CSF fungal cultures and a Histoplasma urine antigen test were negative.


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Rachael Liesman, Ph.D.
Resident, Clinical Microbiology
Mayo Clinic
Instructor in Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine




Elitza Theel, Ph.D.

Elitza Theel, Ph.D.
Consultant, Division of Clinical Microbiology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine


April Josselyn

April Josselyn is a Marketing Associate at Mayo Medical Laboratories. She is the editor of Mayo Clinic PathWays and supports corporate communications strategies and internal communications. She has worked at Mayo Clinic since 2012. Outside of work, April enjoys the outdoors and being "hockey mom" for her two sports-crazed boys.


How could you think of histoplasma infection in the first place ?

The correct answer is Active CNS histoplasmosis.

These kind of exercises, are very useful for us and for our medical residents. Thanks, and I hope continue receiving

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