A 34-year-old man with HIV (CD4 count 60 cells/mm3) presents with headache and left hemiparesis. MRI shows multiple ring-enhancing lesions in the basal ganglia. Toxoplasma IgG is positive. The drug combination recommended for acute treatment is:

• A Albendazole plus praziquantel
• B Isoniazid plus rifampicin plus pyrazinamide
• C Amphotericin B plus flucytosine
• D Pyrimethamine plus sulfadiazine plus folinic acid ✓

Explanation

Cerebral toxoplasmosis in advanced HIV is treated acutely with pyrimethamine plus sulfadiazine, with folinic acid added to limit pyrimethamine-induced myelosuppression. Albendazole plus praziquantel treats neurocysticercosis, which is the main imaging mimic here, but that disease typically shows a scolex or calcified lesions and occurs at higher CD4 counts. Amphotericin with flucytosine is for cryptococcal meningitis, and antitubercular therapy does not address this pathogen.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.