23rd May 2024

A 32-year-old West African lady is seen in the acute medical unit

A 32-year-old West African lady is seen in the acute medical unit. She reports a headache for 2 weeks. On examination, she has nystagmus. She has poor finger nose coordination with dysdiadochokinesia. Bloods show that she is HIV and Hepatitis C positive. Her platelets are 20/mm³. A CT head showed multiple ring enhancing lesions. The largest was 1.3cm, in the medulla, with surrounding oedema. A lumbar puncture was done. The opening pressure was normal. CSF WBC were raised (100% lymphocytes), glucose was within normal limits and protein was slightly elevated. CSF Gram stain and culture were negative. 16-S ribosomal antibodies and GeneXpert of CSF were also negative. No acid-fast bacilli were seen on microscopy, and a TB culture is awaited. JC virus, EBV and CMV PCR were negative. Toxoplasma PCR is positive.

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