A 34-year-old man with AIDS presents with fever, headache, and left hemiparesis. MRI shows multiple ring-enhancing lesions in the basal ganglia. Anti-Toxoplasma IgG is positive. He has a documented severe sulfa allergy. The most appropriate initial therapy is:
- A Pyrimethamine plus clindamycin plus folinic acid ✓
- B Albendazole monotherapy
- C Fluconazole plus amphotericin B
- D Isoniazid, rifampicin, pyrazinamide, ethambutol
Correct answer: A. Pyrimethamine plus clindamycin plus folinic acid
Explanation
Multiple basal ganglia ring-enhancing lesions with positive Toxoplasma serology in an AIDS patient indicate cerebral toxoplasmosis. First-line therapy is pyrimethamine plus sulfadiazine with folinic acid, but in sulfa allergy the standard alternative substitutes clindamycin for sulfadiazine while retaining pyrimethamine and folinic acid. Albendazole treats helminths, antifungals have no activity against this protozoan, and empirical antitubercular therapy would be inappropriate as the initial step given the classic imaging and serology.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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