Hematology Oncology Question 78

A 28-year-old woman is evaluated in the emergency department for a 1-week history of progressive headache associated with nausea and vomiting. Medical history is significant for HIV infection. She is nonadherent to her antiretroviral therapy regimen and takes no other medications.

On physical examination, she is awake and oriented. The patient is afebrile, blood pressure is 130/80 mm Hg, pulse rate is 100/min, and respiration rate is 16/min. No enlarged lymph nodes are palpated. The liver and spleen are not enlarged. The remainder of her physical examination is unremarkable, and her neurologic examination shows papilledema but no other focal findings.

Results of a complete blood count and serum chemistry panel, including toxoplasmosis titer measured at the time of HIV diagnosis, are normal.

CT scan of the head is shown.

Which of the following is the most appropriate next step in management?

A Combination chemotherapy

B High-dose intravenous glucocorticoids

C Intracranial pressure monitoring

D Stereotactic radiation therapy

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