Review Question - QID 106894

The patient's clinical presentation is consistent with a central nervous system infection with Toxoplasma gondii, likely in the setting of acquired HIV from multiple transfusions.

Toxoplasma gondii is a common central nervous system infection in immunocompromised patients that appears as ring-enhancing lesions on MRI. It often presents with several weeks of constitutional symptoms and headaches in addition to focal findings related to the location of the lesions. It occurs in 3-10% of HIV positive patients in the United States and more than 25% of HIV positive patients in Africa. Standard treatment includes pyrimethamine, sulfadiazine, and folic acid.

Figure A shows a CT head with the typical, ring-enhancing lesion of T. gondii infection. Illustration A shows a chest radiograph showing P. jiroveci pneumonia, another common opportunistic infection in patients with AIDS. Illustration B is a photo showing oral thrush, which is caused by Candida albicans and is another common opportunistic infection in patients with AIDS.

Incorrect Answers:
Answer 1: Neurocysticercosis is caused by CNS infection with Taenia solium and typically presents with seizures.
Answer 3: PML, which is caused by the JC virus, does not present with ring-enhancing lesions.
Answer 4: Central nervous system lymphoma can cause ring-enhancing lesions, but the ring is typically more subtle, and fewer lesions are present.
Answer 5: Cryptococcus typically causes meningitis or pneumonia, which are not suggested by this presentation.