This patient developed a worsening, generalized headache over several days' time. When examined by his physician, he had nuchal rigidity. A CBC showed a WBC count of 2200/uL, Hgb 12.7 g/dL, Hct 36.2%, MCV 92 fL, platelet count 109,000/uL, and differential count of 80 segs, 15 lymphs, and 5 monos. Funduscopic examination revealed mild papilledema along with cotton wool spots and retinitis. He was taking zidovudine, stavudine, and ritonavir. The external surface of the brain seen here shows cerebral edema with meningeal clouding. Microscopically with the Gomori methenamine silver (GMS) stain can be seen organisms consistent with Cryptococcus neoformans. Note that the numerous organsisms are poorly encapsulated, if at all, with almost no inflammatory cells, typical for patients who are severely compromised. This patient had the acquired immunodeficiency syndrome.