When Zoster Virus Hides a Primary Brain Lymphoma.

Area of Science:

• Neurology
• Oncology
• Infectious Diseases

Background:

• Herpes zoster ophthalmicus (HZO) can be a prodrome to serious underlying conditions.
• Primary central nervous system lymphoma (PCNSL) is rare and can present with varied neurological symptoms.

Observation:

• A 68-year-old immunocompetent male presented with nausea and vomiting, four months after an HZO diagnosis.
• Neurological examination revealed ptosis, divergent strabismus, and anisocoria.
• Brain imaging identified periventricular lesions consistent with lymphoma.

Findings:

• Biopsy confirmed diffuse large B-cell lymphoma as the cause of PCNSL.
• The patient's presentation was atypical, initially masked by HZO symptoms.
• Despite chemotherapy, the disease progressed rapidly, leading to an inevitable fatal outcome.

Implications:

• HZO in elderly, immunocompetent individuals warrants thorough investigation for occult malignancies.
• Early recognition of PCNSL, even with atypical presentations, is crucial for timely intervention.
• This case highlights the importance of considering neoplasia in patients with seemingly unrelated viral infections.