A 25-year-old man is brought to the emergency department due t | Uworld | Step 2ck

A 25-year-old man is brought to the emergency department due to a generalized tonic-clonic seizure. According to his roommate, the patient has had worsening confusion and lethargy for the last 2 weeks. Today, he had a seizure lasting approximately 3 minutes. The patient has a history of HIV and is not adherent with antiretroviral therapy or other HIV-related medications. He is an active injection drug user. Temperature is 37.7 C (99.9 F), blood pressure is 130/80 mm Hg, pulse is 98/min, and respirations are 16/min. On physical examination,
the patient is somnolent but
arousable. There is no focal extremity weakness or sensory loss. CD4 count is 26/mm3 and viral load is 86,000 copies/ml. MRI of the brain with contrast shows a solitary, irregular, nonhomogenous ring-enhancing lesion in the periventricular area. Cerebrospinal fluid PCR is positive for Epstein-Barr virus DNA.