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A 49 year-old man with a past medical history of hypertension and tobacco use presented to the emergency department after being found by family with altered mental status. Over the previous few months he had experienced progressive fatigue and slurred speech. More recently over a period of days he had experienced flu-like illness with upper respiratory infection, nausea, vomiting and diarrhea with subjective hearing loss. He was subsequently diagnosed with Cryptococcus neoformans meningitis with fungemia due to idiopathic CD4 lymphocytopenia.
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