Table 1 Serum and cerebrospinal fluid (CSF) testing on (a) initial presentation and (b) day 28 after presentation
| Â | (a) | (b) |
|---|---|---|
Serum | Negative studies: Anti-myelin oligodendrocyte glycoprotein antibody Anti-nuclear antibody Angiotensin converting enzyme Human immunodeficiency virus (HIV) p24 antigen HIV1/2 antibodies Cytomegalovirus PCR/IgG/IgM Epstein Barr virus (EBV) IgM Rapid plasma reagin Quantiferon Gold Lyme antibody Coccidiodes antibodies via immunodiffusion Cryptococcal antigen | Negative studies: copper, Vitamin E, folate, cryoglobulins, anti-neutrophilic cytoplasmic antibody, anti-double stranded DNA, anti-cardiolipin antibody, anti-beta-2 glycoprotein, C3/C4, and anti-Ro and anti-La |
CSF | 7 white blood cells × 109/L (WBC) (81% lymphocytes, 16% monocytes, 3% neutrophils), 1 red blood cell × 109/L (RBC) Glucose 48 mg/dL (serum glucose 113 mg/dL) Protein 73 mg/dL (normal: 15–45 mg/dL) Negative studies: CSF bacterial culture Herpes simplex virus (HSV) polymerase chain reaction (PCR) Varicella zoster virus (VZV) PCR VZV IgG Venereal disease research laboratory test | 6 WBC × 109/L (75% lymphocytes, 24% monocytes, 1% neutrophils) 1 RBC × 109/L, glucose 87 mg/dL (serum 158 mg/dL) Protein 57 mg/dL No unique oligoclonal bands IgG Index 0.61 (normal range: 0.28–0.66) Negative studies: Cytology (repeated three times) Flow cytometry without evidence of malignancy HSV PCR VZV PCR/IgG/IgM Human T-cell lymphotropic virus antibody EBV PCR Fungal and acid-fast bacillus cultures Coccidioides antibodies via complement fixation and immunodiffusion Cryptococcal antigen Mycoplasma pneumoniae IgG/IgM West Nile virus antibody Anti-aquaporin 4 antibody Metagenomic next-generation sequencing [1] |