Volume 135, Issue 1, Pages 225-227 (January 2009) A 22-Year-Old Man With Headache and Stiff Neck After a Water Skiing Fall  Kristie Jones, MD, Ekachai Singhatiraj, MD, Rebecca MacDougall, MD, Thomas R. Beaver, MD, Kenneth Nugent, MD, FCCP  CHEST  Volume 135, Issue 1, Pages 225-227 (January 2009) DOI: 10.1378/chest.08-0984 Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 1 Wright-Giemsa-stained cytospin of CSF (original × 400) reveals copious neutrophils (white arrow), lymphocytes (small arrow), and occasional amoeboid structures (large arrow). Note the numerous cytoplasmic vacuoles, pale staining nuclei (asterisk) with prominent karyosome. CHEST 2009 135, 225-227DOI: (10.1378/chest.08-0984) Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 2 Top left, A: Periventricular white matter (hematoxylin-eosin, original × 100). Top right, B: Higher power (original × 1,000) showing amoeba [arrows] associated with edema as well as neuropil destruction. The trophozoite is 20 to 30 microns in size with a large nucleus and a centrally placed karyosome and surrounding halo. Bottom left, C: Brain tissue with positive immunofluorescent staining for anti-N fowleri serum (original × 100). Bottom right, D: Higher power (original × 1,000) showing strongly positive immunofluorescent staining with N fowleri antiserum. CHEST 2009 135, 225-227DOI: (10.1378/chest.08-0984) Copyright © 2009 The American College of Chest Physicians Terms and Conditions