Case 3: A 36-Year-Old with Headache, Fever, and a Seizure

Question | Discussion | References | CME Credit

You answered:

	The presence of more than one mass lesion rules out central nervous system lymphoma.

This answer is incorrect.In general, the presence of multiple brain lesions favors a diagnosis of Toxoplasma encephalitis, whereas a solitary lesion suggests a diagnosis of primary central nervous system lymphoma. Nevertheless, patients with lymphoma can also have multiple brain lesions. Thus, the diagnosis of lymphoma cannot be ruled out by the presence of multiple lesions.

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	Approximately 10% of primary central nervous system lymphomas in patients with AIDS are associated with Epstein-Barr virus (EBV). Performing cerebrospinal fluid (CSF) PCR does not usually provide useful information.
	Based on the clinical presentation and the radiographic findings, the most likely diagnosis is primary central nervous system lymphoma. Radiation therapy should emergently be arranged.
	Based on the clinical and radiographic findings, the most likely diagnosis is Toxoplasma encephalitis. Empiric therapy with pyrimethamine (Daraprim) plus sulfadiazine plus leucovorin should be started.

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