neuroinfectious baseline

A 57-year-old male with an unknown past medical history who recently immigrated from South Asia presents to the emergency department with new-onset skin lesions on his arms. On physical exam, the patient has two large, erythematous lesions with a clearly demarcated but flat border. The nerves around these lesions appear thickened. Biopsy of the lesions shows epithelioid cell granulomas and few bacteria. What is the most likely diagnosis?

A 45-year-old male with AIDs presents with headache and fever. His recent CD4 count was 80, and he does not take his HAART therapy or prophylaxis. You perform a brain MRI (shown below) and discover a contrast-enhancing lesion with much vasogenic edema. With concern for cancer, a biopsy is performed. It shows microglial nodules with encysted bradyzoites and tachyzoites. What is the treatment of choice?

A 4-month-old infant of Amish parents is evaluated in the emergency department for an acute onset of weakness, poor feeding, and irritability that started 2 days ago. Neurologic examination of the child was impressive for ptosis, decreased tone, generalized weakness, a poor suck reflex, and mydriasis. MRI of the brain was normal. Which of the following is the most likely cause of the patient’s symptoms?

A 37-year-old man with poorly controlled diabetes mellitus presents to the emergency department with a three-day history of progressive headache, fever, and double vision. Examination shows bilateral proptosis, peri-ocular erythema, and ophthalmoplegia. CT of the head was ordered and showed bony destruction of the sinuses. Based on the most likely diagnosis, which of the following is the most appropriate treatment?

A 45-year-old man with a past medical history of type 2 diabetes and COPD presents with a 1-week history of fever, headache, and dizziness. Additionally, for the past two days, he has had intractable vomiting. MRI of the brain with and without contrast is shown below. What is the most appropriate treatment for this patient?

A 10-year-old female from the northeastern United Stated presents to the ED with her mother after a one-week history of difficulties in school and difficulties with speech. Her mother states that two weeks ago the patient had a rash on her leg and viral-like symptoms that went away within a few days. Then, this past week the patient’s teacher reported that she was having difficulties with attention in school and was performing very poorly on assignments. Her mother also confirmed that the patient has been more forgetful and is also slurring her speech. An MRI of the brain was performed and it showed multifocal white matter lesions. Of note, the patient likes to spend a lot of time outdoors and recently went on a camping trip. Which of the following is the most likely cause of the patient’s symptoms?

A 30-year-old female with no known past medical history comes to the emergency room after a generalized tonic-clonic seizure. Her friend says that she has been behaving oddly over the past couple of days and has been complaining of a headache. An axial T2 brain MRI is shown below. Which of the following is the most likely diagnosis?

The pathologic findings appreciated on this slide are secondary to which of the following pathologies?

A 35-year-old Dominican Republic immigrant is brought to the emergency room for a first-time seizure. He is currently back to baseline and has a normal neurological exam. His only complaint is a multiple-month history of chronic headaches. A head CT scan is performed and shown below. Which of the following is the most likely etiology of his symptoms?

A 78-year-old man presents to the ER with headache, fever, diplopia, and hiccups. MRI with the brain with and without contrast shows small contrast-enhancing abscesses in the brainstem, sparing supratentorial cerebral tissue. Which of the following infectious agents classically presents in this fashion?

A 15-day-old female is evaluated in the NICU after being born to a G2P2 mother. On exam, the infant is jaundiced. Abdominal ultrasound shows severe hepatosplenomegaly. CT scan of the head shows hydrocephalus and periventricular calcifications, and a fundoscopic exam shows bilateral chorioretinitis. Serological testing is most likely to show infection with which organism?

The pathologic findings marked by the blue arrows in the image below are most likely which of the following?

A 40-year-old with AIDs (CD4 count 60) presents to the emergency room with a 2-month history of progressive headache, confusion, and left sided weakness. MRI brain with and without contrast was performed and it showed ring-enhancing lesions in the basal ganglia and the right frontal lobe. A brain biopsy was performed and shown below. Which is the most likely diagnosis?

A 3-day-old male infant is evaluated in the NICU for fever and focal seizures. He was born at 39 weeks gestation via uncomplicated vaginal delivery and had good APGAR scores. Brain imaging shows periventricular calcifications and severe ventriculomegaly. Auditory testing also demonstrates bilateral hearing impairment. What is the most likely cause of the patient’s symptoms?

A 45-year-old male with a history of IV drug use, HIV, and medication non-compliance is admitted to the hospital with a two-week history of headache, fever, malaise, and double vision. His most recent CD4 count was 180. Lumbar punction is performed. CSF analysis with India ink strain shows encapsulated yeast. Which of the following is the most likely cause of the patient’s symptoms?