5 Days Of Worsening in Medicine / Internal Medicine — 19yo Man | Infectious Diseases | SMLE Q#637
SMLE Question #637
Medicine / Internal Medicine
Infectious Diseases
Last updated: February 2026
A 19-year-old man presents with 5 days of worsening bifrontal headache and 2 days of neck stiffness. He reports intermittent low-grade fever for 1 month and increasing fatigue. Examination shows neck stiffness and a positive Kernig sign. CT head without contrast is unremarkable. Lumbar puncture shows turbid CSF with lymphocyte predominance, elevated protein, and mildly reduced CSF-to-serum glucose ratio. What is the most likely diagnosis?
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