Isolated Abducens Palsy Heralding Occult Human Immunodeficiency Virus–Related Lymphoma

Baartman, Brandon; Adamopoulou, Chrysavgi

doi:10.1080/01658107.2017.1321677

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…Several case reports have described CSS secondary to lymphomatous infiltration as the initial manifestation of HIV, and can initially present as an isolated cranial nerve palsy, similar to our second patient (5,6). Isolated abducens deficits or oculomotor deficits have also been described (7,8). Investigators suggest that in HIV-positive individuals with isolated cranial neuropathy, a diligent and repeated search for lymphoma should be pursued (8).…”

Section: Discussionmentioning

confidence: 99%

HIV-Associated Rapidly Progressive Lymphoma of the Cavernous Sinus

Kvernland¹,

Grossman²,

Levitan³

et al. 2021

Journal of Neuro-Ophthalmology

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A 49-year-old man with newly diagnosed but wellcontrolled HIV on HAART (CD4 + 254, viral load undetectable) presented to the emergency department (ED) with 3 days of right-sided headache, orbital pressure, and acute-onset horizontal binocular diplopia that was worse at distance. Initial examination revealed only an isolated right eye abduction deficit. Laboratory results were notable for elevated inflammatory markers (ESR 82 and CRP 16) and positive serum oligoclonal bands. MRI brain and orbits revealed a T2 hypointense, mildly enhancing, diffusion-restricting lesion in the right cavernous sinus abutting the internal carotid artery (ICA) (Fig. 1A, B). Computed tomography (CT) chest, abdomen, and pelvis revealed a nonspecific right lower lobe nodule. Lumbar puncture with flow cytometry and cytology was unrevealing. The patient received high-dose intravenous steroids, given concern for an inflammatory process without change of symptoms. On rereview of imaging, there was concern for cavernous sinus thrombosis, so therapeutic anticoagulation was also initiated. He was discharged on anticoagulation alone.Two weeks later in neuro-ophthalmology clinic, he noted a change in his binocular horizontal diplopia-now present in all directions of gaze. Examination showed mild right ptosis, 80% adduction, 70% supraduction, 70% abduction, and 40% infraduction of the right eye, and full ocular ductions of the left eye consistent with a new pupilsparing right CN III palsy. Repeat MRI brain and orbits showed interval enlargement of the right cavernous sinus lesion in addition to new skull-based lesions. Repeat cerebrospinal fluid (CSF) flow cytometry revealed a small population of monotypic large B cells. Repeat imaging studies revealed vertebral and omental metastases. CT-guided L2 vertebral biopsy confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL) with CD20-positive, BCL-2, c-myc-negative large B cells. He was treated with highdose intrathecal methotrexate and cytarabine. DISCUSSIONThe most common cause of cavernous sinus syndrome (CSS) is a tumor, including meningioma, schwannoma, hemangioma, congenital cysts, and metastatic disease (2).

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Section: Discussionmentioning

confidence: 99%

HIV-Associated Rapidly Progressive Lymphoma of the Cavernous Sinus

Kvernland¹,

Grossman²,

Levitan³

et al. 2021

Journal of Neuro-Ophthalmology

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“…HIV patients have a significantly increased risk of cancer, with approximately 25–40% of them developing a malignancy in their lives [ 1 ]. Ten percent developing non-Hodgkin lymphoma (NHL) expressly, from this Burkitt lymphoma (BL) represent approximately 25% of NHL in HIV patients [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Isolated Oculomotor Cranial Nerve Palsy as Unusual Presentation of Primary High-Grade Burkitt’s Cell Lymphoma in HIV Patient: Case Report and Literature Review

et al. 2021

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Burkitt lymphoma (BL) is a highly aggressive B-cell neoplasm that is well known to be associated with HIV. The presentation usually reflects the underline immunodeficiency state (like opportunistic infections and chronic diarrhea, and enlarged lymph nodes). The most common causes for 3rd cranial nerve palsy are intracranial aneurysm, ischemia, trauma, and migraine. But for our case, it turned out to be associated with underline HIV and BL, which is an unusual cause. Here, we present a 43-year-old gentleman with no past medical history presented to the emergency department with 4 days history of drooping of left eyelid and headache and binocular diplopia with no other neurological features. CT abdomen showed lymph node enlargement. Lymph node biopsy showed the characteristic of Burkitt’s cell lymphoma. He was started on chemotherapy, but unfortunately, he died. We’re enlightening this case of an isolated oculomotor nerve palsy to diagnose lethal pathology like disseminated BL.

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Isolated Abducens Palsy Heralding Occult Human Immunodeficiency Virus–Related Lymphoma

Cited by 2 publications

References 7 publications

HIV-Associated Rapidly Progressive Lymphoma of the Cavernous Sinus

HIV-Associated Rapidly Progressive Lymphoma of the Cavernous Sinus

Isolated Oculomotor Cranial Nerve Palsy as Unusual Presentation of Primary High-Grade Burkitt’s Cell Lymphoma in HIV Patient: Case Report and Literature Review

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