In HIV patients with CD4 < 100, toxoplasmosis commonly presents with which combination?

• A. Pneumonia and hepatitis
• B. Encephalitis and chorioretinitis
• C. Gastroenteritis and pancreatitis
• D. Myositis and dermatitis

Answer: (B)

Toxoplasma gondii remains latent until the immune system is severely weakened, so in HIV with CD4 below about 100, reactivation commonly hits the brain. Toxoplasmic encephalitis is the hallmark CNS manifestation, producing subacute headaches, confusion or personality changes, focal neurologic deficits, and seizures. Ocular involvement can accompany brain disease, most classically as chorioretinitis (retinochoroiditis), which can cause vision changes or floaters. Seeing both central nervous system symptoms and eye inflammation in this setting is the classic pattern of toxoplasmosis.

Other possibilities don’t fit this pattern as well. For example, CMV retinitis tends to occur with even lower CD4 counts and presents primarily with painless vision loss and characteristic retinal findings, not typically paired with encephalitis. The combos listed involving GI symptoms, dermatitis, or myositis aren’t the expected toxoplasmosis hallmarks in this CD4 range.