A 34-Year-Old Man Comes to the Emergency Department Due to 2

A 34-year-old man comes to the emergency department due to 2 weeks of slowly progressive global headache, malaise, and fevers.  He has also had unintentional weight loss over the past several months.  The patient has a history of injection drug use and was diagnosed with HIV 3 years ago.  He has not been compliant with antiretroviral therapy.  Temperature is 38.3 C (100.9 F) .  Examination shows white patches on the oropharyngeal mucosa and mild generalized lymphadenopathy.  Brain imaging reveals no intracranial masses.  India ink staining of cerebrospinal fluid demonstrates spherical yeast forms with thick capsules.  Which of the following is the most likely site of primary infection in this patient?

A) Intestine
B) Lungs
C) Nasopharynx
D) Oral cavity
E) Skin

Correct Answer:

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