A 30 year old man has had weakness in his left arm and leg for three days. He is HIV positive with a CD4 count of 50 cells/mm3. He is not taking anti-retroviral therapy.
His temperature is 37.5oC, pulse rate 95 bpm and BP 140/90 mmHg. He has power of 3/5 in his left arm and 4/5 in his left leg there is no other focal neurological signs.
CD4 count 50 cells/mm3
CT scan of brain: multiple ring enhancing lesions with surrounding oedema.
What is the most appropriate antimicrobial therapy to prescribe?
- Amphotericin and ceftazidime
- Dexamethasone and acyclovir
- Ganciclovir and ceftazidime
- Isoniazid and rifampicin
- Pyrimethamine and sulphadiazine
E. Pyrimethamine and sulphadiazine
See diagnosis and management of cryptococcal meningitis in: https://bestpractice.bmj.com/topics/en-gb/917