Fungal and Parasitic Infections USMLE Step 1 Practice Question

A 28-year-old woman with systemic lupus erythematosus on chronic corticosteroid therapy presents to the emergency department with a 2-week history of progressive headache, low-grade fever, and neck stiffness. She denies photophobia, rash, or recent travel. Vital signs: BP 118/76 mmHg, HR 102/min, RR 18/min, Temperature 39.2°C, SpO2 98% on room air. Physical examination reveals mild nuchal rigidity but no focal neurologic deficits. Lumbar puncture is performed with the following cerebrospinal fluid (CSF) analysis: protein 350 mg/dL, glucose 45 mg/dL (serum glucose 95 mg/dL), WBC 85/µL (60% lymphocytes), negative Gram stain and bacterial cultures, and positive latex agglutination test for cryptococcal antigen (1:256 titer). Which of the following is the most appropriate initial treatment regimen?