Diagnostic challenges in HIV-associated Burkitt lymphoma initially presenting with multifocal neurological symptoms

A 46-year-old male initially presented with multifocal neurological symptoms including leptomeningeal involvement, multiple cranial nerve palsies, myeloradiculopathy, myelopathy, and cauda equina syndrome. On admission, the patient tested positive for the human immunodeficiency virus (HIV). Based on the initial physical examination, which suggested Guillain-Barré syndrome, plasma exchange was initiated; however, clinical improvement was limited. Further evaluation, including histopathological analysis of the ileocecal mass and flow cytometry of the cerebrospinal fluid, revealed Burkitt lymphoma with widespread involvement of the central and peripheral nervous systems. Despite the early initiation of chemotherapy, the patient died. This case illustrates the diagnostic complexity of neurological presentations in patients with HIV infection and suggests that Burkitt lymphoma may be included in the differential diagnosis of rapidly progressive multifocal neurological symptoms.