CNS Lymphoma
A 32-year-old man who had HIV disease complained of headache, fever, and weakness on his right side. His history included intravenous drug use, Pneumocystis carinii pneumonia, and mucocutaneous candidiasis.
A 32-year-old man who had HIV disease complained of headache, fever, and weakness on his right side. His history included intravenous drug use, Pneumocystis carinii pneumonia, and mucocutaneous candidiasis.
The patient's temperature was 39.8°C (103.6°F). His T-cell count was 32/µL. He had bitemporal atrophy, generalized cachexia, and weakness and diminished sensation of the right upper and lower extremities.
A CT scan of the head revealed a circumscribed, round ring-enhanced lesion in the left parietal lobe. A stereotactic biopsy was performed; CNS B-cell lymphoma was discovered. After 3 weeks of palliative radiation therapy to the brain, the patient died of gram-negative sepsis.
Gopi Rana-Mukkavilli, MD of New York comments that CNS lymphoma in persons with AIDS is indistinguishable from CNS toxoplasmosis and other tumors. Brain biopsy is needed to make a definitive diagnosis.
Radiation therapy is the only treatment that can be offered to these patients, most of whom survive for only a few months after the diagnosis of B-cell lymphoma is made.
