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Isolation of Brain-infiltrating Leukocytes
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Primary Central Nervous System Lymphoma Presenting as Multifocal Brain Abscesses.

Sai Liang1, Jia Xu Lim1, Hwei Yee Lee2

  • 1Neurosurgery, National Neuroscience Institute, Singapore, SGP.

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Summary

A patient with myasthenia gravis developed cerebral abscesses, which were unexpectedly diagnosed as B-cell lymphoma. This case highlights a rare presentation and diagnostic challenge in neuro-oncology.

Keywords:
brain abscesscentral nervous system lymphomaimmunosuppressant

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Area of Science:

  • Neurology
  • Oncology
  • Pathology

Background:

  • A female patient with a history of generalized seropositive myasthenia gravis, treated with mycophenolate mofetil and pyridostigmine, experienced progressive functional decline.
  • Brain MRI revealed multiple cerebral abscesses, prompting treatment with intravenous antibiotics.

Observation:

  • The patient showed no clinical or radiological improvement despite antibiotic therapy.
  • Stereotactic biopsy was performed due to the lack of response.
  • Intraoperative cultures were negative for infection.

Findings:

  • Histological examination of the biopsy revealed B-cell lymphoma.
  • Morphological features were consistent with corticosteroid-treated lymphoma, despite no steroid administration.

Implications:

  • This case presents an unusual diagnosis of B-cell lymphoma mimicking cerebral abscesses in an immunocompromised patient.
  • Highlights the importance of considering alternative diagnoses, including lymphoma, in refractory central nervous system infections.
  • Underscores the diagnostic challenges and potential for atypical presentations in patients with autoimmune diseases and immunosuppressive therapy.