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Toxoplasma Non-Response Biopsy — SCE Infectious Diseases MCQ

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HardCNS InfectionToxoplasma Non-Response BiopsySCE Infectious Diseases

A patient with advanced HIV has a ring-enhancing brain lesion and positive Toxoplasma IgG but shows no clinical or radiological response after 14 days of correctly delivered empirical therapy. What is the next diagnostic step?

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Correct answer: B — Stereotactic biopsy for lymphoma or another alternative diagnosis

The best answer is “Stereotactic biopsy for lymphoma or another alternative diagnosis”. Failure to improve within the expected 10-to-14-day window makes the presumptive diagnosis unsafe; tissue diagnosis is needed when feasible to distinguish PCNSL and other infections or tumours. BHIVA guidance governs investigation and treatment of HIV-associated disease and supports standard specialist care when HIV is virologically controlled.

Reference: BHIVA clinical guidelines: https://bhiva.org/clinical-guidelines/