Giardia duodenalis Infection and Pachymeningitis in a Patient With Agammaglobulinemia.
Gamze Sonmez, Cigdem Kaya, Merve Erdem et al.
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Case in brief
A 14-year-old patient with X-linked agammaglobulinemia presented with persistent fever, bloody diarrhea, and headache. Chronic giardiasis was identified, and brain MRI showed minimal diffuse dural thickening interpreted as pachymeningitis. The illness worsened, with thrombocytopenia and hepatitis. Empirical immunosuppressive therapy was started, but the patient died. The report describes Giardia infection alongside suspected pachymeningitis in a profoundly immunocompromised patient; it does not establish that Giardia caused the dural inflammation.
What made this case unusual
The report describes chronic giardiasis in a patient with pachymeningitis-like MRI findings, an association the authors note had not been reported. The relationship between the infection and neurological findings remains uncertain.
Diagnostic / clinical pearl
In a patient with X-linked agammaglobulinemia, persistent fever and neurological symptoms warrant careful evaluation; dural thickening interpreted as pachymeningitis does not by itself establish Giardia as the cause.