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

Question | Discussion | References | CME Credit

You answered:

	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.

This answer is incorrect. More than 75% of primary central nervous system (CNS) lymphomas in patients with AIDS are associated with Epstein-Barr virus (EBV). A CSF specimen can provide useful information, as a positive PCR for EBV strongly suggests a diagnosis of primary CNS lymphoma.

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