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Question

5.A middle-aged man with diagnosis of AML with inv(16) has achieved complete remission with induction therapy. Consolidation therapy with high-dose cytarabine (HiDAC), 3,000 mg/m2, twice daily on days 1 to 6 was started for him. The patient lives in the Ohio River Valley. He has not taken his acyclovir prophylaxis due to musculoskeletal pain. Also, due to significant insurance co-pay, he has not taken his posaconazole for history of fungal pneumonia. Laboratory tests at the beginning of treatment were normal, except for a creatinine of 1.7 mg/dL. Three days after admission, the patient complained of minimal gait disturbance. The next day, he developed ataxia, nystagmus, and dysarthria. What is the most likely diagnosis?

A. Cytarabine-induced cerebellar toxicity

B. CNS tumor lysis of resistant AML stem cells

C. Histoplasma meningitis

D. HSV encephalitis

E. CNS leukemia with core binding factor cytogenetic abnormality