Primary central nervous system plasmablastic lymphoma in an HIV-positive patient

BMJ Case Rep. 2019 Mar 14;12(3):e226755. doi: 10.1136/bcr-2018-226755.

Abstract

Plasmablastic lymphoma (PBL) is a rare subtype of diffuse large B-cell lymphoma, highly associated with HIV and Epstein-Barr virus (EBV) infections. It commonly presents in extranodal sites, often an oral mass, but reports of primary central nervous system PBL (PCNSPBL) are exceedingly rare. Here, we report on a 33-year-old man with newly diagnosed HIV infection who presented with acute-onset unilateral visual disturbance and was found to have biopsy-proven PCNSPBL. The neoplastic cells displayed a plasmacytoid appearance, with the expression of CD38 and CD138, and were positive for EBV by in situ hybridisation for EBV-encoded RNA. Systemic workup revealed the presence of Kaposi sarcoma, but no evidence of lymphoma. He is currently being treated with high-dose methotrexate, as well as antiretroviral therapy for his HIV infection, and has achieved a complete response.

Keywords: CNS cancer; HIV / AIDS; malignant and benign haematology.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antimetabolites, Antineoplastic / therapeutic use
  • Antiretroviral Therapy, Highly Active / methods
  • Central Nervous System Neoplasms / metabolism
  • Central Nervous System Neoplasms / pathology*
  • Central Nervous System Neoplasms / virology
  • Epstein-Barr Virus Infections / complications
  • HIV / isolation & purification
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • Herpesvirus 4, Human / genetics
  • Humans
  • Male
  • Methotrexate / administration & dosage
  • Methotrexate / therapeutic use
  • Plasmablastic Lymphoma / drug therapy
  • Plasmablastic Lymphoma / metabolism
  • Plasmablastic Lymphoma / pathology*
  • Plasmablastic Lymphoma / virology
  • Rare Diseases
  • Sarcoma, Kaposi / complications
  • Sarcoma, Kaposi / pathology
  • Treatment Outcome

Substances

  • Antimetabolites, Antineoplastic
  • Methotrexate