A 50-year-old man from India presents with multiple brain ring-enhancing lesions. He is HIV-positive with a CD4 count of 40 cells/µL. Empirical treatm...

Question

A 50-year-old man from India presents with multiple brain ring-enhancing lesions. He is HIV-positive with a CD4 count of 40 cells/µL. Empirical treatment for toxoplasmosis is commenced. After 2 weeks there is no clinical or radiological improvement. What is the next step?

Accepted Answer

Stereotactic brain biopsy to establish the diagnosis, as primary CNS lymphoma is the main alternative diagnosis in this setting

Answer

Continue toxoplasmosis treatment for another 4 weeks

Answer

Switch to antifungal therapy

Answer

Start anti-TB treatment empirically

Answer

Discharge with outpatient follow-up

uk-dtmh MCQ (SBA): Brain Biopsy for Non-responding Ring Lesions

A 50-year-old man from India presents with multiple brain ring-enhancing lesions. He is HIV-positive with a CD4 count of 40 cells/µL. Empirical treatment for toxoplasmosis is commenced. After 2 weeks there is no clinical or radiological improvement. What is the next step?