HIV-associated cerebral lymphocyte infiltration mimicking vestibular schwannoma

Abstract

The association of unilateral, rapidly progressive hearing loss, tinnitus and vestibular dysfunction in combination with a contrast-enhancing mass within the internal auditory canal on MRI is suggestive of a vestibular schwannoma (VS). We report the rare finding of a HIV-associated cerebral lymphocyte infiltration, most probably malignant lymphoma, which was presumed initially to be a VS. A 36-year-old male presented with progressive unilateral hearing loss accompanied by acute, ipsilateral tinnitus. Interpreted first as sudden sensorineural hearing loss, his symptoms were treated with rheologic therapy. Ipsilateral facial palsy appeared. MRI with gadolininium disclosed a contrast-enhancing mass within the internal auditory meatus of the left side. Within five weeks an extended leptomeningeal lymphocyte infiltration evolved and the diagnosis of an underlying HIV infection was made. Unilateral, rapidly progressive hearing loss and a fast growing cerebello-pontine mass is atypical for VS and highly suspicious of malignant disease. To our knowledge we report the first case of an HIV-associated cerebral lymphocyte infiltration, mimicking a VS. In such cases the diagnostic work-up should include a HIV test.

Hearing loss in people with HIV/AIDS and associated factors: an integrative review

“…To analyze and discuss the occurrence of hearing disorders in HIV/AIDS patients and its associated factors in the selected papers, they were organized in topics. Since it was not possible to group the studies by methodological similarity, we chose to group the findings by adherence to theme, namely: “Virus action 9 , 15 , 16 , 21 , 22 and ototoxicity” 9 , 15 , 16 , 17 , 20 , 26 ; and “Opportunistic diseases and hearing loss” 17 , 18 , 19 , 21 , 22 , 24 , 25 .…”

“…In an MRI they suspected of a vestibular schwannoma; however, when they ordered the anti-HIV they found the patient was serum-positive. The authors recommended a thorough exam to investigate the cause of the hearing loss 26 .…”

“…24 Senegal/2005 Epidemiological, clinical, etiological features of neuromeningeal diseases at the Fann Hospital Infectious Diseases Clinic, Dakar Retrospective study Determine the prevalence of cerebromeningeal diseases, and describe epidemiological data, clinical and etiological characteristics Opportunistic diseases Shahab I, Osbone BM, Butler JJ. 25 USA/1994 Nasopharyngeal Lymphoid Tissue Masses in Patients with Human Immunodeficiency Virus Histology findings and clinical correlation Check for a correlation between HIV-1 and nasopharyngeal lymphoma Opportunistic diseases Wenzel GI, Götz F, Lenarz T, Stöver T. 26 Germany/2008 HIV-associated cerebral lymphocyte infltration mimicking vestibular schwannoma Case study Report the first case of HIV associated with primary cerebral lymphocytes. Ototoxicity …”

The First Case of Vestibulocochlear Neuritis in a Patient with Acquired Immunodeficiency Syndrome in Korea

“…Unlike in patients negative for HIV, opportunistic infections and HIV itself must be considered in the etiologic evaluation of SSHL, or vestibular neuritis in patients with HIV infection. When SSHL arises in immunocompromised patients, they should undergo evaluations for possibly severe causes of SSHL such as CMV infection, syphilis, or schwannoma [ 3 ]. In the absence of opportunistic infections, early initiation of therapy with high-dose glucocorticoid could improve the neurologic outcome and quality of life in AIDS patients.…”

“…However, sudden sensorineural hearing loss (SSHL) due to vestibulocochlear neuritis has rarely been reported [ 1 ]. In the literature, there are a few case reports describing vestibulocochlear neuritis in patients with AIDS, including two cases associated with HIV seroconversion syndrome [ 1 2 ], one case due to cerebral lymphocytic infiltration [ 3 ], two cases caused by cytomegalovirus (CMV) infection [ 4 ], and two cases with otosyphilis [ 5 6 ]. Herein, we report the first case of vestibulocochlear neuritis in an AIDS patient in Korea.…”