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Intracranial lymphoma in human immunodeficiency virus-infected patients: A diagnostic dilemma?
Rajkumar Gurubuxrai Harjani1, Ritika Harjani Hinduja2, Asha Krishnaraj Iyer1
1Center for Excellence in HIV/AIDS, Ashirwad Hospital, Thane, Maharashtra, India.
Insights
Primary central nervous system lymphoma in HIV patients can be difficult to diagnose, even with advanced imaging. This case highlights the importance of considering this aggressive malignancy despite initial normal findings.
Area of Science:
- Neuro-oncology
- Infectious Diseases
- Diagnostic Imaging
Background:
- Primary central nervous system (CNS) lymphoma is an aggressive malignancy and an acquired immunodeficiency syndrome-defining illness.
- Early diagnosis and prompt management are crucial for improving cure rates in CNS lymphoma.
- Human immunodeficiency virus (HIV) positivity is a risk factor for developing primary CNS lymphoma.
Observation:
- A 42-year-old male with HIV presented with persistent fever and a perianal ulcer.
- Initial diagnostic workup, including PET-CT and MRI of the brain, showed normal findings.
- The patient developed neurological symptoms (dizziness, loss of balance), prompting repeat imaging.
Findings:
- Repeat imaging revealed a space-occupying lesion in the cerebellum, indicative of primary CNS lymphoma.
- Despite initiating treatment, the patient's condition did not improve.
- The patient succumbed to the illness within 4 months of treatment initiation.
Implications:
- This case underscores the diagnostic challenges of primary CNS lymphoma in HIV-positive individuals, especially with initially negative imaging.
- A high index of suspicion and repeat investigations may be necessary for timely diagnosis.
- Delayed diagnosis and treatment can lead to poor outcomes in aggressive CNS malignancies.
Abstract:
Primary central nervous system (CNS) lymphoma is an aggressive malignancy which constitutes one of the acquired immunodeficiency syndrome -defining illnesses. Early diagnosis and timely management can increase the chances of cure. Although many times the diagnosis is straightforward, we present a case of primary CNS lymphoma in a human immunodeficiency virus--positive individual which posed as a major diagnostic dilemma with initially normal imaging findings. A 42-year-old male presented with unremitting fever and a perianal ulcer for 3 months. A battery of diagnostic tests were negative, including a positron emission tomography-computed tomography scan and a magnetic resonance imaging brain. With unresolving symptoms and a high index of suspicion as he developed dizziness and loss of balance, the same were repeated which confirmed a space-occupying lesion in the cerebellum. Although treatment was instituted, the patient did not recover and died in the 4th month of treatment.
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