ID Fellows Cup Question 27

A 60 year-old male with history of myelodysplastic syndrome who underwent Allogenic Matched Unrelated Donor Stem Cell transplant 35 days prior now presents from clinic with new confusion. The patient engrafted 8 days prior (Day 27) and course was complicated only by mild graft vs host disease. His medications include tacrolimus and prednisone. Family describes the patient as “foggy”: forgetting tasks in middle of completion, and not remembering conversations or events like meals. Also mood seemed irritable and “out of character”. The patient had no problems with long term memory.

ID was consulted 24 hours into admission after patients confusion progressed to somnolence. Serum cell counts consistent with recent engraftment ANC -1800.

CSF with WBC -10 (90% lymph), Protein 75, RBC 0, Protein 75 MRI Brain (below)


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