Match each HIV-positive patient's clinical presentation and neuroimaging or cerebrospinal fluid (CSF) finding with the most likely causative pathogen or etiology.
- A 35-year-old with a CD4 count of presents with new-onset seizures. Brain MRI shows multiple ring-enhancing lesions primarily in the basal ganglia with surrounding edema.Toxoplasma gondii
- A 42-year-old with a CD4 count of presents with progressive hemiparesis and speech difficulty. Brain MRI reveals asymmetric, non-enhancing white matter lesions without mass effect.JC virus
- A 38-year-old with a CD4 count of presents with headache, fever, and neck stiffness. CSF analysis demonstrates an elevated opening pressure and is positive for encapsulated yeast organisms on India ink stain.Cryptococcus neoformans
- A 40-year-old with a CD4 count of presents with progressive confusion. Brain MRI shows a solitary, weakly ring-enhancing periventricular mass. CSF polymerase chain reaction is positive for a specific oncogenic virus.Epstein-Barr virus
Answer
The correct matches correlate characteristic neuroradiological and CSF findings with their specific opportunistic etiologies: multiple ring-enhancing lesions match with Toxoplasma gondii, non-enhancing white matter lesions match with JC virus, elevated CSF opening pressure with encapsulated yeast matches with Cryptococcus neoformans, and a solitary periventricular mass with oncogenic viral DNA matches with Epstein-Barr virus.
In advanced HIV, distinct CNS pathogens produce hallmark clinical and radiological phenotypes. Toxoplasma gondii causes multiple ring-enhancing lesions. JC virus targets oligodendrocytes, causing non-enhancing white matter demyelination without mass effect (PML). Cryptococcus neoformans causes meningoencephalitis with characteristically high opening pressure. Epstein-Barr virus drives Primary CNS Lymphoma, typically appearing as a single periventricular mass.
Step-by-Step Solution
Key Concept
Diagnosis of central nervous system opportunistic infections in HIV/AIDS based on neuroimaging and cerebrospinal fluid analysis.
Estimated Time:1m 30s