A 34-year-old man with untreated HIV infection presents with progressive confusion and left hemiparesis. MRI shows a solitary homogeneously enhancing lesion abutting the right lateral ventricle with mild surrounding edema. CSF analysis shows positive Epstein-Barr virus DNA by PCR. Which organism is the established driver of this central nervous system lymphoma?
- A JC polyomavirus
- B Toxoplasma gondii
- C Epstein-Barr virus ✓
- D Human herpesvirus 8
Correct answer: C. Epstein-Barr virus
Explanation
Primary CNS lymphoma in immunosuppressed patients is an EBV-driven B-cell neoplasm; virtually all such tumours carry EBV genomes, and CSF EBV DNA has high sensitivity and specificity for the diagnosis. Toxoplasmosis typically produces multiple ring-enhancing lesions with disproportionate edema rather than a solitary homogeneous mass, and JC virus causes progressive multifocal leukoencephalopathy, a demyelinating process without mass enhancement.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.