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Case 1: A 39-Year-Old with Headache, Fever, and Confusion

You answered:

C The clinical history is most compatible with progressive multifocal leukoencephalopathy (PML). A cerebrospinal fluid test positive for Epstein-Barr virus (EBV) would be diagnostic of PML.

This answer is incorrect. The clinical presentation for PML typically does not include fever. Although contrast CT scans are often normal with PML, brain MRI typically shows extensive white matter lesions. The cause of PML is JC virus, not EBV.

A The diagnosis of Toxoplasma encephalitis is the most likely diagnosis even though the contrast brain CT is normal; approximately 40% of AIDS patients with Toxoplasma encephalitis will have a normal contrast brain CT.
B The patient's clinical history is compatible with cryptococcal meningitis. The diagnosis of cryptococcal meningitis should not be ruled out with only 7 leukocytes/mm3 found in the cerebrospinal fluid.
D The patient's findings suggest a diagnosis of central nervous system lymphoma. The diagnosis is confirmed with a cerebrospinal fluid test positive for human herpes virus 8.

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