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

Question | Discussion | References | CME Credit

You answered:

	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.

This answer is incorrect. Most patient's with central nervous system lymphoma present with a focal finding and evidence of a mass lesion on brain imaging. Virtually all of these lymphomas show evidence of Epstein-Barr virus in the lymphomatous tissue. Human herpes virus 8 has no known association with central nervous system lymphomas.

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	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.
	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.
	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.

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