CASE 63
A 30-year-old white woman was brought to the emergency department of a local hospital with a 2-week history of progressively severe headache, nausea, and vomiting; several seizures had occurred over the past 2 days.
LABORATORY STUDIES
Imaging
Head MRI revealed ring-enhancing lesions in the left parietal lobe and right frontal lobe (Fig. 63-1).
Diagnostic Work-Up
Table 63-1 lists the likely causes of illness (differential diagnosis). A clinical diagnosis of encephalitis was considered based on the evidence of brain lesions. Investigational approach may include
TABLE 63-1 Differential Diagnosis and Rationale for Inclusion (consideration)
Rationale: Focal brain lesions are due to only a few causes in patients with AIDS. T. gondii and CNS lymphoma—the most common causes—can usually be differentiated based on lab and radiologic findings, although clinically, they may manifest similarly. The first three organisms are more likely to cause meningitis, as opposed to mass lesions with neurologic deficits. The other causes are much less common, and they may or may not exhibit ring enhancement. PML does not usually cause mass lesions.
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