A 42-year-old man is sent to the emergency hospital after his family witnesses a widespread tonic-clonic seizure. He has no history of seizures, although he has had migraines for several weeks. The patient is employed in the construction industry. He has no prior international travel experience and has never owned a pet. Every day, he smokes a pack of cigarettes and consumes 3-4 cans of beer. A postictal condition, mouth thrush, and many enlarged cervical and inguinal lymph nodes are noteworthy on physical examination. The picture below is an MRI of his brain with contrast. Which of the following is the most likely cause of this patient's symptoms?

Question

A 42-year-old man is sent to the emergency hospital after his family witnesses a widespread tonic-clonic seizure. He has no history of seizures, although he has had migraines for several weeks. The patient is employed in the construction industry. He has no prior international travel experience and has never owned a pet. Every day, he smokes a pack of cigarettes and consumes 3-4 cans of beer. A postictal condition, mouth thrush, and many enlarged cervical and inguinal lymph nodes are noteworthy on physical examination. The picture below is an MRI of his brain with contrast.  Which of the following is the most likely cause of this patient's symptoms?

Quizplus · Accepted Answer

Eductional Objective: Given his oral thrush (often found with a CD4 level of 200/mm3), cervical and inguinal lymphadenopathy, and brain abnormalities, this patient is most certainly infected with HIV. Toxoplasmic encephalitis is characterized by headaches, seizures, and numerous ring-enhancing central nervous system (CNS) lesions on MRI (white arrows) in HIV patients. Seizures are a typical consequence of brain lesions and the edema that surrounds them. Toxoplasmosis can also be spread through contaminated foods, therefore extensive pet (cat) exposure is not required for diagnosis.

A 42-Year-Old Man Is Sent to the Emergency Hospital After