Review Question - QID 109296

A 60-year-old African American male with a history of AIDS presents to the emergency room complaining of a headache. He reports a two-week history of progressively worsening diffuse headache, nausea, vomiting, fever, and confusion. His past medical history is notable for diabetes mellitus, hypertension, and major depressive disorder. He takes metformin, glyburide, hydrochlorothiazide, sertraline, and anti-retroviral therapy but admits to not taking his medications regularly. He has a history of intravenous drug use and a 25 pack-year smoking history. His temperature is 100.6°F (38.1°C), blood pressure is 150/85 mmHg, pulse is 115/min, and respirations are 20/min. Physical examination reveals mild neck stiffness. Strength, sensation, and reflexes are normal in the upper and lower extremities bilaterally. Findings from a stained blood smear are shown in Figure A. A brain MRI and lumbar puncture are planned. Which of the following findings on brain MRI is most consistent with this patient’s condition?