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ANCA-associated rapidly progressive glomerulonephritis — RCPSC IM MCQ

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HardNephrologyANCA-associated rapidly progressive glomerulonephritisRCPSC IM

A patient with advanced HIV has headache, fever and focal weakness. MRI shows multiple ring-enhancing basal-ganglia lesions; CD4 count is 35 cells/µL. There is no mass effect. What initial diagnostic-treatment approach is most appropriate?

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Correct answer: C — Start anti-toxoplasma therapy and reassess clinically

In advanced HIV with a typical toxoplasmosis syndrome and no immediate neurosurgical indication, empiric anti-toxoplasma treatment with planned response assessment is appropriate. Biopsy is reserved for atypical or nonresponsive disease; steroids, antibacterial therapy or ART alone do not treat the likely opportunistic infection.

Reference: Public Health Ontario, Infectious Diseases Resources: https://www.publichealthontario.ca/