Epstein‑Barr virus‑associated primary central nervous system lymphoma in an immunosuppressed patient with a comorbid autoimmune disorder: A case report

Bricoune,Ornella; Kareem,Syeda Saba; Wallace,Gerald; Iacono,David P.; Macaulay,Robert; Etame,Arnold; Pina,Yolanda; Robinson,Timothy J.; Mokhtari,Sepideh

doi:10.3892/etm.2023.12109

August-2023 Volume 26 Issue 2

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August-2023 Volume 26 Issue 2

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Case Report Open Access

Epstein‑Barr virus‑associated primary central nervous system lymphoma in an immunosuppressed patient with a comorbid autoimmune disorder: A case report

Authors:
- Ornella Bricoune
- Syeda Saba Kareem
- Gerald Wallace
- David P. Iacono
- Robert Macaulay
- Arnold Etame
- Yolanda Pina
- Timothy J. Robinson
- Sepideh Mokhtari
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Affiliations: Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA, Department of Pharmacy, Moffitt Cancer Center, Tampa, FL 33612, USA, Department of Pathology, Moffitt Cancer Center, Tampa, FL 33612, USA, Department of Radiation Oncology, Yale Cancer Center, New Haven, CT 06520, USA

Copyright: © Bricoune et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Article Number: 410
|
Published online on: July 10, 2023

https://doi.org/10.3892/etm.2023.12109
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Abstract

Patients with primary central nervous system lymphoma (PCNSL) typically present with non‑focal neurological symptoms, including disorientation, poor balance and memory loss with unifocal or multifocal periventricular lesions seen on MRI. Deviations from these characteristic findings can delay diagnosis and lead to additional diagnostic tests being needed. The present study reports a 68‑year‑old man with a recent varicella zoster infection and history of acetylcholine receptor antibody‑positive myasthenia gravis who received mycophenolate mofetil for 22 years. He presented with left eye vision changes and cognitive memory deficits. A brain MRI showed an enhancing lesion within his left medulla extending to the cerebellum. Cerebrospinal fluid analysis was positive for Epstein‑Barr virus (EBV) and negative for malignancy. He was diagnosed with varicella zoster virus vasculopathy. At 3 months later, a repeat brain MRI showed multiple new enhancing lesions developing bilaterally along the periventricular white matter. Soon after, he presented to a local ER with acute left‑sided blurry vision and worsening memory loss, and he began receiving steroids. Because of rapid symptom progression, he underwent resection of the left frontal lesion, which showed EBV‑induced diffuse large B‑cell lymphoma (DLBCL). Mycophenolate mofetil was discontinued, and within 24 h of one dose of intravenous 500 mg/m2 rituximab, he had a dramatic improvement in left eye vision and memory loss. He experienced mixed responses to rituximab after 3 cycles. Following one dose of high‑dose methotrexate, he developed subsequent chronic kidney disease and required dialysis. He received whole‑brain radiation therapy with craniospinal radiation and is currently in complete remission. An EBV‑induced DLBCL diagnosis should be highly considered for patients with periventricular lesions and EBV‑positive cerebrospinal fluid. Misdiagnosis or delay in PCNSL diagnosis because of atypical features in disease presentation and radiographic findings could lead to PCNSL progression and worsening neurological deficits.

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Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Epstein‑Barr virus‑associated primary central nervous system lymphoma in an immunosuppressed patient with a comorbid autoimmune disorder: A case report

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