Spinal compression due to Burkitt lymphoma in a newly diagnosed HIV-infected child

We describe a newly diagnosed HIV-infected child, without prior history of AIDS-defining disease, who presented with Burkitt lymphoma-related cauda equina syndrome that rapidly progressed to a flaccid paraplegia. Diagnosis was confirmed on biopsy and magnetic resonance imaging of the spine showed multiple epidural masses with involvement of several vertebral bodies, cord edema and compression of the cord and cauda equina. The child's immune status was relatively preserved and Epstein-Barr serology proved negative. Chemotherapy (LMB 89 modified protocol) was initiated immediately after histopathologic confirmation, together with highly active antiretroviral therapy. A follow-up magnetic resonance imaging 6 weeks later showed segmental cord atrophy at the site of previous edema despite complete resolution of all the epidural masses. Unfortunately, the child's neurologic state did not improve beyond the recovery of sphincter control and lower limb sensation. The patient is the first reported case of Burkitt lymphoma-related spinal cord compression as an initial AIDS-defining illness, in a 10-year-old child. The outcome of the case highlights the importance of early diagnosis and prompt treatment of this aggressive tumor to avoid permanent neurologic deficits.