A 25-year-old man from Bihar presents with chronic headache, focal seizures, and multiple ring-enhancing lesions on contrast MRI. CSF shows lymphocytes 80/microL, protein 120 mg/dL, and glucose 25 mg/dL (serum 90 mg/dL). Acid-fast stain is negative. What is the most appropriate initial treatment?

• A Amphotericin B and flucytosine
• B Pyrimethamine-sulfadiazine
• C Albendazole and dexamethasone
• D Four-drug antitubercular therapy with corticosteroids ✓

Explanation

Multiple ring-enhancing lesions in an endemic region with CSF showing lymphocytic pleocytosis, raised protein, and low glucose are classic for tuberculous meningitis. Empirical four-drug ATT (rifampicin, isoniazid, pyrazinamide, ethambutol) with corticosteroids is standard. Neurocysticercosis typically has normal CSF glucose and single lesions. Negative AFB stain does not exclude TBM.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.