Case Presentation A 34-year-old male with a history of alcohol and drug abuse, no other significant past medical history. The patient presented with complaints of a 5-6 day history of severe headache, frontal/midline in location with associated nausea and vomiting, generalized fatigue, and personality changes per family members. Admission labs within normal limits, except LDH elevated at 1483. HIV negative. CT scan of the head at the time of presentation revealed hydrocephalus; the central nervoys system (CNS) was negative for infectious etiology. MRI revealed small nodular ependymal enhancement involving lateral ventricle, third ventricle, and aqueduct. Subsequent brain biopsy revealed large B-cell lymphoma; the remainder of the workup was negative for disease, which included bone marrow biopsy/aspiration, CT scan chest/abdomen/pelvis, negative CNS cytospin × 3, and peripheral serum/CNS flow analysis to evaluate abnormal cell population.
Discussion Primary CNS lymphoma was previously considered a rare disease, but with the increase of HIV cases, there has been an increased incidence. Primary CNS lymphoma remains a relatively rare disease in immunocompetent individuals, accounting for ˜ 0.5-1.5% of all intracranial neoplasms in immunocompetent individuals.
Demographics Primary CNS lymphoma diagnosed in immunocompetent individuals typically occurs between ages 45 and 70; frequency increases with increasing age, with a small male predominance.
Clinical Presentation Single intracranial lesions are the most common finding in immunocompetent individuals. Classical symptoms include headache, blurred vision, motor difficulties, and personality changes.
Treatment Treatment generally consists of high-dose methotrexate, with or without radiation therapy.