A 32-year-old man with AIDS presents with headache, fever, and left hemiparesis. MRI shows multiple ring-enhancing lesions with surrounding oedema. Anti-Toxoplasma IgG antibody is positive. First-line treatment consists of:

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

Explanation

Cerebral toxoplasmosis is the commonest focal CNS infection in AIDS patients with positive Toxoplasma serology, and first-line therapy is the antifolate combination of pyrimethamine and sulfadiazine, with folinic acid given to prevent myelosuppression. Albendazole and praziquantel treat helminthic disease such as neurocysticercosis, amphotericin with flucytosine treats cryptococcal meningitis, and antitubercular therapy addresses tuberculomas, none of which matches the serology here.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.