MRCP2-3510
A 35 year old male Intravenous drug user presents to genito-urinary clinic. He was diagnosed with HIV 2 years ago after presenting with tuberculosis (TB). He was treated for TB for 6 months. He is now on third line anti-retroviral therapy for previous virological failure and co-trimoxazole. His most recent CD4 count was 110, and his viral load was 2,500 copies/ml.
He complains of weakness on his right side, and deterioration in hearing, getting worse for three weeks. He has a severe headache. On examination his hearing is reduced in his right ear and normal in his left ear. He has weakness, in his right arm and leg, brisk reflexes and mildly increased tone.
He is immediately admitted.
A CT scan shows several ring enhancing lesions in his left cerebral hemisphere and one on the right cerebral hemisphere.
On audiological review he has a large area of cochlear necrosis in his right ear.
What is the diagnosis?