Abstract
Background: Acquired immunodeficiency syndrome (AIDS)-related primary central nervous system lymphoma is an AIDS-defining disease that usually occurs when the CD4 count is less than 50 cells/ml. The frequency of the disease has substantially decreased in the era of highly active antiretroviral therapy (HAART). Prognosis is poor with rapid progression leading to death within 2-3 months if left untreated.Case description: a 65 years old male presented to medical attention with gait disturbance, weight loss and slight left-sided hemiparesis. Human immunodeficiency virus infection was diagnosed with an initial CD4 count of 116 cells/ml and a viral load of 260’000 copies/ml. Magnetic resonance imaging of the brain revealed three brain lesions involving the right frontal lobe and the left parietal lobe, which on biopsy led to a diagnosis of AIDS-related primary central nervous system lymphoma. HAART was initiated with whole-brain radiotherapy, and the patient declined systemic chemotherapy. Due to poor performance status, he was transferred to palliative care. Under HAART, he slowly recovered with normalization of CD4 count and undetectable viral load. Medical imaging showed complete remission of the brain lesions. At 3-year follow-up, the patient remains in complete remission, but presented mild neurocognitive dysfunction possibly secondary to whole-brain radiotherapy.Conclusion: Nowadays, treatment paradigm parallels that of primary central nervous system lymphoma in the immunocompetent population based on systemic chemotherapy (primarily high-dose intravenous methotrexate and steroids) in association with HAART. The role of whole-brain radiotherapy is questionable because of late neurotoxic effects.
Long-term Remission of AIDS-related Primary Central Nervous System Lymphoma in a Patient Under Antiretroviral Therapy: A Case Report and Review of the Literature
