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Primary central nervous system lymphoma masquerading as herpes encephalitis: clinical, magnetic resonance imaging,

Pierre Giglio1, Rohit Bakshi, Sandra Block

  • 1Department of Neurology, and Kaleida Health, State University of New York at Buffalo School of Medicine and Biomedical Sciences, USA.

The American Journal of the Medical Sciences
|January 30, 2002
PubMed

Insights

Primary central nervous system lymphoma (PCNSL) can mimic herpes simplex encephalitis, presenting with similar symptoms and MRI findings. Early biopsy is crucial for accurate diagnosis and appropriate treatment of PCNSL.

Area of Science:

  • Neurology
  • Oncology
  • Radiology

Background:

  • Primary central nervous system lymphoma (PCNSL) is a rare malignancy.
  • Herpes simplex encephalitis (HSE) is a common cause of viral encephalitis with distinct clinical and imaging features.
  • Distinguishing PCNSL from HSE is critical for timely and appropriate management.

Observation:

  • An 84-year-old male presented with acute confusion, aphasia, and fever.
  • MRI revealed T2/FLAIR hyperintensities in the left temporal, frontal lobes, and insula, suggestive of viral encephalitis.
  • Despite acyclovir treatment, the patient's condition worsened, necessitating further investigation.

Findings:

  • A left temporal lobe biopsy confirmed the diagnosis of primary central nervous system lymphoma (PCNSL).
  • The MRI findings, initially presumed to be HSE, were characteristic of PCNSL.
  • This case highlights the overlapping imaging spectrum of PCNSL and HSE.

Implications:

  • PCNSL can present with clinical and radiological features mimicking herpes simplex encephalitis.
  • Neuroimaging findings alone may not be sufficient to differentiate PCNSL from HSE.
  • Brain biopsy remains essential for definitive diagnosis in ambiguous cases of suspected CNS infections or malignancies.

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