Cranial neuropathy heralding otherwise occult AIDS-related large cell lymphoma

Three HIV-infected patients developed cranial neuropathy as the initial manifestation of an AIDS-related large cell lymphoma. All were homosexual men known to be HIV seropositive for 3 to 4.5 years. At the time of presentation for neurological disease, the CD4 T-lymphocyte count was < 400 cells/m...

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Published inJournal of clinical neuro-ophthalmology Vol. 13; no. 2; pp. 113 - 118
Main Authors BERGER, J. R, FLASTER, M, SCHATZ, N, DROLLER, D, BENEDETTO, P, POBLETE, R, DONOVAN POST, M. J
Format Journal Article
LanguageEnglish
Published New York, NY Raven Press 01.06.1993
Subjects
Adult
AIDS/HIV
Biological and medical sciences
CD4-Positive T-Lymphocytes - pathology
Cranial Nerve Diseases - diagnosis
HIV Infections - diagnosis
HIV Seropositivity
HIV-1
Humans
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Leukocyte Count
Lymphoma, AIDS-Related - diagnosis
Lymphoma, Large B-Cell, Diffuse - diagnosis
Magnetic Resonance Imaging
Male
Medical sciences
Human
Immunopathology
Nervous system diseases
Homosexuality
AIDS
Malignant hemopathy
Hemopathy
Disorders of cranial nerves
Lymphoma
Infection
Case study
Eye disease
Lymphoproliferative syndrome
Viral disease
Young adult
Ophthalmoplegia
Paralysis
Oculomotor syndrome
Oculomotor nerve
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Summary:Three HIV-infected patients developed cranial neuropathy as the initial manifestation of an AIDS-related large cell lymphoma. All were homosexual men known to be HIV seropositive for 3 to 4.5 years. At the time of presentation for neurological disease, the CD4 T-lymphocyte count was < 400 cells/mm3 in each. Initial manifestations were retro-orbital headache and oculomotor nerve palsy in two and an abducens nerve palsy in the other. Repeatedly negative CSF cytologies and recovery of the cranial neuropathy obscured the diagnosis. These patients illustrate that cranial neuropathy with HIV infection may herald the presence of an occult large cell lymphoma. Spontaneous or corticosteroid-associated improvement of the cranial neuropathy, absence of abnormalities on brain imaging studies, and negative CSF cytologies do not exclude this diagnosis. We suggest that a diligent and repeated search for lymphoma be considered in HIV-infected patients presenting with cranial neuropathy, including repeated CSF examinations, MRI of brain and spine (T1 and T2) with and without gadolinium enhancement, chest and abdominal CT scans, and bone marrow biopsy.
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ISSN:0272-846X