Presentation
Altered mental status and diarrhea with a history of HIV/AIDS.
Patient Data
MRI Brain w + w/o Contrast
There is a left frontal horn intraventricular/periventricular ring-enhancing lesion measuring 2.4 x 2.3 x 2.5 cm with internal necrosis, surrounded by large vasogenic edema causing regional mass effect.
Additionally, there is FLAIR hyperintensity surrounding the third ventricular region, interpeduncular region, and anterior midbrain without definite enhancement. Mild ill-defined underlying restricted diffusion. This likely represents lymphomatous spread. Some of the lesions showed restricted diffusion.
There is a FLAIR hyperintensity surrounding the right peritrigonal region and right frontal horn with associated sub-ependymal enhancement on postcontrast, likely representing lymphomatous spread.
Mild hydrocephalous is seen. Additionally, there is a ring-enhancing lesion within the right temporal horn measuring 1.4 x 1.1 cm with surrounding small vasogenic edema.
A minimal amount of intraventricular hemorrhage was noted bilaterally.
Case Discussion
This represents a case of CNS lymphoma. The patient is a 35-year-old male with a medical history of HIV/AIDS (CD4 = 10.92) who presented to the emergency department with fever, severe diarrhea, nausea, and altered mental status. As a part of his workup, a CT scan revealed an ill-defined mass. An MRI later revealed findings concerning a lymphoma. A stereotactic biopsy confirmed CNS lymphoma. The patient started chemoradiation therapy.
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