{"ops":[{"insert":"A 40 year old Caucasian patient presents with difficulty in speaking and walking for 3 days, in a background of fever and fatigue for 1 week.\n\nHe has been HIV-positive for 7 years. Close questioning reveals poor compliance with HAART.\n\nThere is no contact history with tuberculosis nor a travel history to South America. He keeps a cat as a pet.\n\nHe is allergic to sulfa-drugs. A CD4 count is performed and is found to be 100 cells\/microL.\n"},{"insert":"\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-M-141_en.png"}},{"insert":"\n"}]}
2
Investigate
Lumbar Puncture
{"ops":[{"insert":"CSF analysis: protein 70 mg\/dL (18 - 58 mg\/dL) . \nAll other indices within normal parameters\nNegative for Acid Fast Bacilli and cryptococcal antigens.\nPCR for HSV-1 and HSV- 2 : negative\nPCR for M. tuberculosis : negative\nPCR for T. gondii: positive\n"}]}
MRI Brain
{"ops":[{"insert":"The gadolinium enhanced MRI scan shows multiple, small, ring enhancing lesions involving the right frontal lobe, right thalamus and right superior cerebellar peduncle, with surrounding edema. \nThe lesion in the right frontal lobe demonstrates the \u0027eccentric target sign\u0027. A mass effect is not evident.\n"}]}
