A 39-year-old man with non–insulin-dependent diabetes mellitus was admitted to a hospital in Zimbabwe because of a severe headache. Evaluation of the cerebrospinal fluid revealed a white-cell count of less than 5 per cubic millimeter. Diagnostic tests were performed.

This case was presented at the Ninth Annual Workshop on Advanced Clinical Care–AIDS in Durban, South Africa (organized by Drs. Henry Sunpath and Mahomed-Yunus S. Moosa [Infectious Diseases Unit, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal] and Dr. Rajesh T. Gandhi [Massachusetts General Hospital and the Ragon Institute] and sponsored by the Harvard University Center for AIDS Research [NIH P30 AI060354], McCord Hospital, the University of KwaZulu-Natal, the South African HIV Clinicians Society, and the KwaZulu-Natal Department of Health).

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

Dr. Makadzange reports receiving honoraria from GlaxoSmithKline and Janssen Pharmaceuticals and being an employee of Gilead Sciences. No other potential conflict of interest relevant to this article was reported.

Dr. Rajesh T. Gandhi served as a guest editor for this case. We thank Dr. Admire Hlupeni for assistance with details of the clinical course for the case history and outpatient follow-up and Dr. Margaret Borok for assistance with details of the inpatient course.

Source Information

From the Department of Medicine, University of Minnesota Medical Center and University of Minnesota Medical School, Minneapolis (D.R.B.); and the Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (A.T.M.).