For which of the following patients would you recommend prophylaxis against mycobacterium avium-intracellulare?
A30-year old HIV positive male with CD4 count of 20 cells/microliter and a viral load of < 50 copies/mL
B22-year old HIV positive female with CD4 count of 750 cells/microliter and a viral load of 500,000 copies/mL
C45-year old HIV positive female with CD4 count of 250 cells/microliter and a viral load of 100,000 copies/mL
D50-year old HIV positive female with CD4 count of 150 cells/microliter and a viral load of < 50 copies/mL
E36-year old HIV positive male with CD4 count of 75 cells/microliter and an undetectable viral load
A 58-year-old woman with HIV infection is brought to the emergency department because of a 2-week history of headaches, blurred vision, and confusion. Her current medications include antiretroviral therapy and trimethoprim-sulfamethoxazole. Neurological examination shows ataxia and memory impairment. Her CD4+ T-lymphocyte count is 90/μL. Cerebrospinal fluid analysis shows lymphocytic predominant pleocytosis, and PCR is positive for Epstein-Barr virus DNA. An MRI of the brain with contrast shows a solitary, weakly ring-enhancing lesion with well-defined borders involving the corpus callosum. Which of the following is the most likely diagnosis?
AGlioblastoma multiforme
BCerebral toxoplasmosis
CPrimary cerebral lymphoma
DProgressive multifocal leukoencephalopathy
EAIDS dementia
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 the 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 respirations are 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 3600/mm3 Platelet count 140,000/mm3 CD4+ count 56/μL HIV viral load > 100,000 copies/mL Serum Cryptococcal antigen negative Toxoplasma gondii IgG positive An MRI of the brain shows disseminated, nonenhancing white matter lesions with no mass effect. Which of the following is the most likely diagnosis?
AVascular dementia
BPrimary CNS lymphoma
CNeurocysticercosis
DCerebral toxoplasmosis
EProgressive multifocal leukoencephalopathy
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