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HIV and Its Complications and Needlestick Injuries
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
A pragmatic approach to ring-enhancing lesions in HIV is to treat for toxoplasma first (pyrimethamine, sulphadiazine and folinic acid). If there is no clinical improvement after 2–3 weeks, consider empirical TB treatment. If no improvement, consider non-infectious aetiology, for example Primary Central Nervous System Lymphoma (PCNSL).
AIDS-Related Malignancy
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Mark Bower, Elena Gervasi, Alessia Dalla Pria
Primary central nervous system lymphoma (PCL) is defined as non-Hodgkin lymphoma (NHL) that is confined to the cranio-spinal axis without systemic involvement. This diagnosis is rare in immunocompetent patients but occurs more frequently in patients with both congenital and acquired immunodeficiency. Since 1985 high-grade B-cell NHL including PCL has been an AIDS-defining diagnosis. AIDS-related PCL occurs equally frequently across all ages and transmission risk groups. A meta-analysis of cohort studies has shown a significant decline in the incidence of PCL following the introduction of highly active antiretroviral therapy (HAART) (relative risk 0.42)30 which is attributed to the protective effects of HAART.31
Epstein–Barr virus and the nervous system
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Alexandros C. Tselis, Kumar Rajamani, Pratik Bhattacharya
Primary CNS lymphoma (PCNSL) is a neoplasm of the brain usually seen in the elderly and in the immunosuppressed. With the advent of the HIV-AIDS epidemic, this tumor has become much more common, especially in patients with advanced HIV disease. In a series of 20 cases of PCNSL reported in 1986, all but one had one or more opportunistic infections or neoplasms (such as Kaposi’s sarcoma) [23]. The known oncogenic effects of EBV and its association with systemic lymphomas suggests that the virus may play an important role in this tumor, and in fact, the virus is found in all AIDS-associated PCNSL [92,93] but only in about 50% of systemic lymphomas in HIV patients. In situ hybridization studies have shown that the neoplastic cells all express the latency molecule EBER and LMP, which are associated with immortalizations of infected lymphocytes. Control dishes from the brains of both HIV positive and HIV negative patients with other diagnoses showed no such expression [92]. In another study, primary CNS lymphoma samples from 26 AIDS and 22 HIV negative patients were tested for EBV by in situ hybridization for EBER and immunostaining for LMP-1. All AIDS-associated PCNSLs were positive for EBV infection, whereas none of the HIV negative cases were. Rare instances of EBV-positive PCNSL in HIV negative patients have been reported [94].
A case of primary central nervous system lymphoma presenting as a shunt complication
Published in British Journal of Neurosurgery, 2023
Roberto J. Perez-Roman, Zachary S. Hubbard, G. Damian Brusko, Robert M. Starke
Primary central nervous system lymphoma (PCNSL) accounts for 3–5% of primary brain tumors, with an annual incidence of five per one million person-years.1–3 It is a category of extranodal non-Hodgkin lymphoma located within the brain, eyes, leptomeninges, and spinal cord.1–3 In 95% of cases, PCNSL consists of diffuse, large B-cell infiltrates. The remaining cases are either low-grade B-cell or T-cell origin.1,3 PCNSL is usually associated with immunosuppression but has recently been found with increasing frequency among immunocompetent individuals.4 Patients typically present with generalized symptoms such as headache, nausea, vomiting, and confusion.5 Despite advances in radiologic techniques, the diagnosis of PCNSL remains a challenge. In this article, we describe a case of periventricular PCNSL in an 82-year-old female presenting as a shunt malfunction.
Fluorescein sodium-guided resection of a cerebellar lymphoma: case report and literature review
Published in British Journal of Neurosurgery, 2023
Andrea Franzini, Edvin Zekaj, Alberto Bona, Andrea Ciuffi, Mauro Porta, Domenico Servello
Primary central nervous system lymphoma (PCNSL) is an extranodal non-Hodgkin lymphoma accounting for less than 5% of primary brain tumors.1,2 Since the radiological appearance of PCNSL is not univocal, histological confirmation is often necessary to guide therapy. Currently, stereotactic biopsy or open surgical biopsy followed by adjuvant therapies are considered the primary modality of treatment. By contrast, total or subtotal resection is rarely performed, as it does not carry a clear prognostic advantage its prognostic role is still debated.3,4 The main indication to proceed with resection is the association of the mass lesion with intracranial hypertension or neurological deterioration.3,5 Furthermore, an open surgical approach may be adopted for sampling lesions in the posterior fossa, where the stereotactic biopsy procedure entails serious technical and surgical problems.6
Optic nerve biopsy in leukemic infiltrative optic neuropathy: a case report and review of the literature
Published in Orbit, 2022
Paul D. Chamberlain, Christopher R. Dermarkarian, M. Brent Woodland, Richard C. Allen, Nagham Al-Zubidi
Table 1 summarizes cases in the current literature where an optic nerve biopsy was performed to aid in the diagnosis of leukemia or lymphoma.3,5–14 Including the current case, 13 optic nerve biopsy cases were reported. Of note, this does not include cases where only optic nerve sheath biopsy was performed. Seven had known leukemia/lymphoma of which six were in clinical remission at the time of presentation. Five were an initial presentation of primary central nervous system lymphoma. Of the 13 patients, 7 had NLP vision, 3 had LP, HM, or CF vision, and 2 had 20/80 vision at the time of biopsy (1 not reported). Of the five patients with LP vision or better prior to biopsy, at least three had CF vision or better following biopsy (2 not reported).