skip to main content

Cerebral Toxoplasmosis — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateInfectious DiseasesCerebral ToxoplasmosisRACP Adult Medicine

A 50-year-old man with HIV on antiretroviral therapy (CD4 350, undetectable viral load) develops progressive headache over 2 weeks. MRI brain shows a ring-enhancing lesion in the right basal ganglia with surrounding oedema. His IgG serology for Toxoplasma gondii is positive. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Empirical treatment for cerebral toxoplasmosis (pyrimethamine + sulfadiazine + folinic acid)

In HIV patients with positive Toxoplasma IgG serology and a ring-enhancing brain lesion, empirical treatment for cerebral toxoplasmosis is standard practice. The regimen is pyrimethamine + sulfadiazine + folinic acid for 6 weeks, followed by maintenance therapy. Clinical and radiological response within 2 weeks supports the diagnosis. If no improvement, brain biopsy should be considered to exclude primary CNS lymphoma (PCNSL), which typically shows a single lesion and is associated with EBV.

Reference: eTG – 2025 – Antibiotic Guidelines; ASHM – 2024 – HIV/OI Management