Stereotactic Brain Biopsy in Human Immunodeficiency Virus—Infected Patients

A 50-year-old man who had been living in Thailand presented with a history of falls, deteriorating vision and weight loss over several months. He had been admitted to a hospital in Thailand where he was given a diagnosis of multiple sclerosis. Neurological examination revealed a mild ataxic gait and lateral nystagmus, but no other abnormalities. He tested positive for human immunodeficiency virus with a CD4 cell count of 16 cells/µL. Brain magnetic resonance imaging was suggestive of an intrinsic neoplasm and he underwent stereotactic brain biopsy which showed numerous yeast-like organisms. Panfungal polymerase chain reaction was positive for Histoplasma capsulatum. He received liposomal amphotericin B for six weeks, followed by itraconazole, and started antiretroviral therapy four weeks into treatment. He developed an immune reconstitution inflammatory syndrome which responded well to steroids. Six months after diagnosis, he has no neurological symptoms or signs and remains on itraconazole. Isolated bulky central nervous system histoplasmomas are exceedingly rare. A clinical suspicion of immunosuppression was key in making this diagnosis.

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Primary central nervous system lymphoma presenting as multiple space-occupying lesions in advanced human immunodeficiency virus infection

South African Journal of Radiology ◽

10.4102/sajr.v21i2.1234 ◽

2017 ◽

Vol 21 (2) ◽

Author(s):

Sara Zafar ◽

Maria Javed ◽

Neesha Rockwood ◽

Farhat Kazmi

Keyword(s):

Central Nervous System ◽

Human Immunodeficiency Virus ◽

Nervous System ◽

Central Nervous System Lymphoma ◽

Brain Biopsy ◽

Emission Tomography ◽

Radiological Imaging ◽

Positron Emission ◽

Immunodeficiency Virus ◽

Cerebellar Symptoms

A 31-year-old man presented with seizures and cerebellar symptoms on a background of weight loss and lethargy. He was found to be infected with human immunodeficiency virus (HIV) and following radiological imaging, was commenced on treatment for presumed cerebral toxoplasmosis. Due to a lack of response, both clinically and on interval imaging, a positron-emission tomography-computed tomography and brain biopsy were undertaken, which demonstrated high-grade primary central nervous system lymphoma (PCNSL). Awareness amongst both clinicians and radiologists of the multifarious patterns of intra-cranial involvement in patients with HIV is, therefore, of utmost importance, as the treatment and prognosis of these entities are entirely different.

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Gliosarcoma: An Unusual Cause of Cerebral Mass Lesion in a Patient with AIDS

The Neuroradiology Journal ◽

10.1177/197140090802100614 ◽

2008 ◽

Vol 21 (6) ◽

pp. 835-838

Author(s):

M. Corti ◽

N. Trione ◽

E. Muzzio ◽

C. Yampolsky ◽

D. Lewi ◽

...

Keyword(s):

Highly Active Antiretroviral Therapy ◽

Stereotactic Biopsy ◽

Opportunistic Infections ◽

Brain Biopsy ◽

Histopathological Diagnosis ◽

Cerebral Lesion ◽

Stereotactic Brain Biopsy ◽

Highly Active ◽

Immunodeficiency Virus ◽

The Central Nervous System

Malignant glioma is the most common primary brain neoplasm. Generally, gliomas are not included in the differential diagnosis of enhancing lesions of the central nervous system in patients infected by the human immunodeficiency virus. We report a case of gliosarcoma in a patient with AIDS presenting as a single cerebral lesion. Stereotactic brain biopsy was obtained and definitive histopathological diagnosis of gliosarcoma was made. A decline in the incidence of opportunistic infections associated with highly active antiretroviral therapy suggest the importance of early stereotactic biopsy to confirm the diagnosis of these neoplasms.

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