A 26-year-old man comes to the physician for a follow-up examination. He was diagnosed with HIV infection 2 weeks ago. His CD4+ T-lymphocyte count is 162/mm3 (N ≥ 500). An interferon-gamma release assay is negative. Prophylactic treatment against which of the following pathogens is most appropriate at this time?
ACytomegalovirus
BToxoplasma gondii
CMycobacterium tuberculosis
DAspergillus fumigatus
EPneumocystis jirovecii
A 63-year-old man with non-Hodgkin lymphoma is brought to the emergency department because of fever and confusion that have progressively worsened over the past 3 days. He also has a 3-day history of loose stools. He returned from France 2 weeks ago where he stayed in the countryside and ate typical French cuisine, including frog, snail, and various homemade cheeses. His last chemotherapy cycle was 3 weeks ago. He is oriented to person but not to place or time. His temperature is 39.5°C (103.1°F), pulse is 110/min, and blood pressure is 100/60 mm Hg. Examination shows cervical and axillary lymphadenopathy. The lungs are clear to auscultation. There is involuntary flexion of the bilateral hips and knees with passive flexion of the neck. Neurologic examination shows no focal findings. Laboratory studies show: Hemoglobin 9.3 g/dL Leukocyte count 3600/mm3 Platelet count 151,000/mm3 Serum Na+ 134 mEq/L Cl- 103 mEq/L K+ 3.7 mEq/L Glucose 102 mg/dL Creatinine 1.3 mg/dL A lumbar puncture is performed. Cerebrospinal fluid analysis shows a leukocyte count of 1200/mm3 (76% segmented neutrophils, 24% lymphocytes), a protein concentration of 113 mg/dL, and a glucose concentration of 21 mg/dL. The results of blood cultures are pending. Which of the following is the most appropriate initial pharmacotherapy?
AAcyclovir and dexamethasone
BVancomycin, ampicillin, and cefepime
CAmpicillin, gentamicin, and dexamethasone
DAmpicillin and cefotaxime
EAcyclovir
A 44-year-old man is brought to the emergency department by his daughter for a 1-week history of right leg weakness, unsteady gait, and multiple falls. During the past 6 months, he has become more forgetful and has sometimes lost his way along familiar routes. He has been having difficulties operating simple kitchen appliances such as the dishwasher and coffee maker. He has recently become increasingly paranoid, agitated, and restless. He has HIV, hypertension, and type 2 diabetes mellitus. His last visit to a physician was more than 2 years ago, and he has been noncompliant with his medications. His temperature is 37.2°C (99.0°F), blood pressure is 152/68 mm Hg, pulse is 98/min, and respiratory rate is 14/min. He is somnolent and slightly confused. He is oriented to person, but not place or time. There is mild lymphadenopathy in the cervical, axillary, and inguinal areas. Neurological examination shows right lower extremity weakness with normal tone and no other focal deficits. Laboratory studies show: Hemoglobin 9.2 g/dL Leukocyte count 3,600/mm3 Platelet count 140,000/mm3 CD4+ count 56/µL HIV viral load > 100,000 copies/mL Serum Cryptococcal antigen Negative Toxplasma gondii IgG Positive An MRI of the brain is shown below. Which of the following is the most likely diagnosis?
ACryptococcal meningoencephalitis
BProgressive multifocal leukoencephalopathy
CHIV encephalopathy
DPrimary CNS lymphoma
ECerebral toxoplasmosis
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