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Washington University Experience | NEOPLASMS (HEMATOLYMPHOID) | Lymphoma, immune-compromised | 3A0 Case 16 History
Case 3 History ---- The patient was a 37 year old man with AIDS diagnosed by positive serology and with pneumocystis carinii pneumonia in 4/88. Other complications included chronic herpes simplex ulcer of the right leg (4/88), CMV retinitis {4/89), and Kaposi's sarcoma of the left lower lobe of the lung (10/89). On 11/89 he was admitted with nausea, vomiting and dehydration. GI studies were normal. MRI of the head revealed multiple gadolinium enhancing lesions of increased T2 signal in both cerebral and cerebellar hemispheres, deep white matter and brainstem. An LP revealed CSF glucose 37, protein 114, negative VDRL, cryptococcal antigen negative, total cells 10, nucleated 14 (93% mono, 7% PMN). On 11/29 MRI stereotactic frontal brain biopsy was consistent with B cell lymphoma. He began whole brain XRT on 12/1 and completed 4000 rads on 12/29. CT of the head at that time was "improved"; however, he continued to experience progressive debilitation with diffuse weakness. Neurologic exam on 12/30 showed a left sluggish pupil, ptosis and incomplete right eye adduction and hyperreflexia. He developed fevers of unknown etiology and became more obtunded and died.
