Infectious Disease
Case 32: An HIV ‐Positive Patient with a Right Hemiparesis
CASE
A 35‐year‐old sex worker presented with a subacute history of right‐sided limb weakness and headache. She was diagnosed with HIV on this presentation. Examination revealed a right hemiparesis without sensory involvement; there were no signs of raised intracranial pressure and she remained afebrile throughout.
The following results were available to you:
CSF Appearance Clear Microscopy No organisms seen WCC 2 cells/mm3 RCC 10 cells/mm3 Biochemistry Protein 0.45 g/L Glucose >50% Cryptococcal antigen Negative EBV PCR Elevated CMV/VZV/HSV PCR Not detected Syphilis serology Negative
Enhanced CT of the head (ring‐enhancing lesion) (Fig. 0012)
QUESTION 1
Your score this session: 0 of 0
She had a trial of anti‐Toxoplasma treatment for 1 month but there was no objective improvement. What is the most likely diagnosis?
