A 50-year-old HIV seropositive male presented to the ER with multiple episodes of generalized tonic-clonic seizures. Patient is not on HAA. CD4 count was done and it was 45/ microL. O/E, Mildly arousable Disoriented No nuchal rigidity or focal neurological deficits Gadolinium enhanced MRI and MR spectroscopy were conducted. Which is the most appropriate drug to be given in the above condition: -

This is a case of cerebral toxoplasmosis in the setting of HIV-AIDS. MRI shows a number of lesions in the brain parenchyma with surrounding edema - suggestive of toxoplasmosis. Increased lipid peak and decreased choline peak on spectroscopy differentiates it from primary CNS lymphoma. Patients of HIV with CD4 count < 100/ microL - risk of toxoplasmosis Causes encephalitis. Combinations approved are: - 1st choice - Pyrimethamine + Sulphadiazine Alternative -Trimethoprim + Sulphomethoxazole