A woman in her 60s with chronic meningitis

A renal transplant recipient in her 60s presented with a history of chronic headaches and progressive encephalopathy. Serial cerebrospinal fluid examinations were consistent with chronic lymphocytic meningitis, but no definitive cause was identified. Imaging studies showed the development of an enhancing suprasellar mass lesion and hydrocephalus. Symptoms progressed despite empiric antimicrobial therapy, and the patient died after an acute large-volume subarachnoid hemorrhage. A complete autopsy was performed. The differential diagnosis, pathologic findings, and diagnosis are discussed.