Question:easy

A patient with HIV and a CD4 count <40 cells/mm³ presents with a ring-enhancing lesion in the brain on contrast imaging. What is the most likely diagnosis?

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CD4 <100 plus ring enhancement in HIV → think the commonest opportunistic CNS infection first.
Updated On: Jun 25, 2026
  • Lymphoma
  • Toxoplasma
  • Tuberculosis
  • Progressive multifocal leukoencephalopathy (PML)
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The Correct Option is B

Solution and Explanation

The vignette gives two anchors: severe immunodeficiency (HIV, CD4 $<40$/mm³) and a ring-enhancing intracranial mass. Both point to an opportunistic process rather than a tumour.

In AIDS, the differential for ring-enhancing lesions is led by toxoplasmosis, which reactivates when CD4 falls below ~100. On imaging it gives multiple peripherally enhancing nodules with central necrosis and vasogenic oedema, favouring the basal ganglia and corticomedullary junction. The standard approach is empirical sulfadiazine + pyrimethamine; radiological improvement at 2 weeks confirms it.

The competing entities behave differently: primary CNS lymphoma is usually solitary, periventricular, shows restricted diffusion and avidly takes up thallium/FDG; a tuberculoma is a reasonable but less typical lead here; and PML produces non-enhancing demyelinating white-matter lesions and therefore cannot explain ring enhancement.

Hence the single best answer is toxoplasmosis.
\[\boxed{\text{Toxoplasma encephalitis}}\]
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