title: Cryptococcal meningitis associated with increased adenosine deaminase in the cerebrospinal fluid.
abstract: BACKGROUND
  Clinically, increased cerebrospinal fluid (CSF) adenosine deaminase (ADA) level is an important diagnostic clue of tuberculous meningitis. However, increased CSF ADA level can be caused by other neurological diseases.
  
  
  METHODS
  We report a case of a 67-year-old woman with cryptococcal meningitis presented with increased ADA level of the CSF. In parallel with her recovery, the ADA level of CSF decreased steadily. This is the first case described the chronological change in CSF ADA level of the patient with cryptococcal meningitis in detail.
  
  
  RESULTS
  Clinically, increased CSF ADA level is an important diagnostic clue of tuberculous meningitis. However, previously, it was reported that increased CSF ADA level can be caused by other neurological diseases. In this case, the patient was diagnosed with cryptococcal meningitis, and the possibility of coinfection with tuberculous meningitis has been discarded by the negative PCR, negative cultures and the clinical course. In addition, the chronological change in CSF ADA level was useful for follow-up assessment.
  
  
  CONCLUSIONS
  Cryptococcal meningitis should be considered for the differential diagnosis for diseases presented increased CSF ADA.
authors.affiliation: Department of Neurology, Gifu Municipal Hospital, 7-1 Kashima-Cho, Gifu City, 500-8513 Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Neurology, Gifu Municipal Hospital, 7-1 Kashima-Cho, Gifu City, 500-8513 Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Satomi
keywords: Adenosine deaminase; Cerebrospinal fluid; Cryptococcal meningitis; Differential diagnosis; Follow up