Primary CNS lymphoma
Background
- Caused by Epstein-Barr virus (EBV)
- Occurs with profound immunosuppression (CD4 counts <50cells/uL)
- Accounts for approximately 20 to 30% of CNS lesions in patients with AIDs
Clinical Features
- Can present with a variety of focal or nonfocal signs and symptoms
- Confusion, lethargy, memory loss, hemiparesis, aphasia, mental status changes, seizures
- Constitutional symptoms (systemic B symptoms)
Differential Diagnosis
Evaluation
- CT scan: well-defined focal lesion, isodense or hyperdense to the gray matter
- MRI scan (higher diagnostic yield): variable, isointense or hypointense lesions on T1-weighted images
- Lesions that involve the corpus callosum, periventricular, or periependymal areas are more likely to be due to a lymphoma
- Lumbar puncture: CSF cytology
- CSF EBV PCR
- Should also obtain toxoplasma serologies, most are treated empirically for toxoplasma while serology is pending
- Stereotactic brain biopsy if needed
Management
- High-dose methotrexate therapy (3 g/m2 for four to eight cycles)