Relationship Between CNS Infections, Stroke, and Neurological Complications: A Case Series

Central nervous system infections and complications such as meningitis and stroke in immunocompromised patients can be caused by a wide spectrum of pathogens, including bacteria, viruses, parasites, or fungi. This case series first presents a case of a 24-year-old Latino male patient with HIV, cytomegalovirus (CMV) encephalitis, a positive CSF for Coccidioides antigen, and a stroke, who presented to the primary care office with a headache and double vision. With his symptoms now occurring for more than two months without improvement, the patient was sent to the ED for a repeat MRI, where an enlargement of his ventricles compatible with hydrocephalus was observed. This patient was diagnosed with coccidioidal meningitis and sent to a different facility for neurosurgical management. The second case describes a 28-year-old White male patient living with HIV and struggling with polysubstance use, who presented to the ED with a stroke and encephalopathy. Labs to address his underlying cause of encephalopathy showed a positive rapid plasma reagin (RPR) titer, and MRI results were consistent with bilateral acute ischemic infarcts of syphilitic vs. HIV-associated vasculitis. The patient was placed on aspirin, corticosteroids, and high-dose antibiotics. A prognosis of coccidioidal meningitis and neurosyphilis can be fatal if left untreated; as a result, this case series emphasizes the need for prompt stroke management and workup, especially in the context of infection and/or encephalopathy. Discovering the underlying cause of stroke can not only address the patient's current symptoms but also prevent future stroke occurrence.