ID Fellows Cup Question 5

A 38-year old male with recently diagnosed HIV (CD4 count 95, not currently on any medications) presents to the hospital with subacute onset of fever and headache. His partner reports that the patient has had worsening confusion over the last few days. Vital signs are stable and exam notable for ataxia.

T2 MRI imaging of the brain shows the following:

(Case and imaging courtesy of Assoc Prof Frank Gaillard, Radiopaedia.org, rID: 5472)

Serum Toxoplasma IgG: Positive Serum CMV IgG: Positive

Serum Cryptococcal Ag: Negative

  • Lumbar Puncture CSF studies:
    • mild mononuclear pleocytosis elevated protein
    • Gram stain and culture negative at 24 hours

Click page 2 below to see answer and explanation!

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