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HIV – Cerebral Toxoplasmosis — SCE Neurology MCQ

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ModerateCNS InfectionsHIV – Cerebral ToxoplasmosisSCE Neurology

A 43-year-old with untreated HIV (CD4 count 48 cells/mm³) presents with headache, confusion and a focal seizure. MRI shows multiple ring-enhancing lesions involving the basal ganglia with surrounding oedema. Toxoplasma IgG is positive. There is no lesion with a periventricular or subependymal pattern. What is the most appropriate initial strategy?

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Correct answer: C — Start empiric anti-toxoplasma therapy with early clinical and radiological reassessment

In advanced HIV, multiple basal-ganglia ring-enhancing lesions with positive prior toxoplasma exposure support an empiric anti-toxoplasma treatment trial with early reassessment. Toxoplasma IgG alone indicates prior exposure and is not diagnostic; a solitary periventricular lesion would raise more concern for primary CNS lymphoma. Failure to improve should prompt urgent reconsideration of the differential and tissue diagnosis where appropriate.

Reference: British HIV Association guideline for the management of HIV-associated opportunistic infections.