Fungal and Parasitic Infections USMLE Step 1 Practice Question
A 42-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 3 days of confusion. Temperature is 39.2°C, blood pressure 118/76 mmHg, heart rate 102/min, respiratory rate 20/min, and oxygen saturation 98% on room air. Physical examination reveals neck stiffness and photophobia. Cerebrospinal fluid (CSF) analysis shows: white blood cell count 180/μL (85% lymphocytes), protein 120 mg/dL, glucose 20 mg/dL, and negative Gram stain and bacterial culture. Serum glucose is 95 mg/dL. India ink stain is pending. Which of the following is the most appropriate empiric management?
Answer choices
- AAmphotericin B deoxycholate with flucytosineCorrect answer
- BIsoniazid, rifampin, pyrazinamide, and ethambutol
- CCeftriaxone and vancomycin monotherapy
- DFluconazole alone pending culture results
- EAcyclovir with ganciclovir
- FMeropenem with ampicillin
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