Question of the Week # 87

Q87) A 42 year old african-american man is admitted to hospital with acute seizures. Seizures were appropriately controlled in the ER and the patient currently, in post-ictal confusion. He is unable to give further history. However, a review of the old records reveal that the patient has history significant of Chronic HIV infection. He also has a history of IV drug use. As per his sister, the patient has been compliant with Highly active anti-retroviral therapy and prophylactic medications for Pneumocystis jiroveci and Mycobacterium Avium Complex for the past one year. His recent CD4 count 1 month ago was 45. On physical examination, he is afebrile with a blood pressure of 120/60.  He is confused. Reflexes are intact. Electrolytes and CBC are with in normal limits. Urine drug screen is negative. A non-contrast CT scan did not not reveal any bleed. A CT scan with IV contrast reveals a 4 cm ring – enhancing lesion in left cerberal hemisphere. A  subsequent MRI brain confirmed the findings on the CT. There is no mass effect. Next step in approaching this patient ?

A. Stereotactic Brain Biopsy

B. Start emperic Toxoplasma therapy.

C. Obtain Toxoplasma Serology ( IgM and IgG)

D. PCR for Papova Virus JC

E. Emperic therapy for CNS tuberculosis.

 

4 Responses

  1. b…

  2. bbb toxoplasmosis

  3. B

  4. B

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