Linfoma cerebral primario en una paciente inmunocompetentepresentación de un caso y revisión de la literatura
- Daniel Martínez-Martínez 1
- Jacobo García-Fernández 1
- Taysa Benítez-Delgado 1
- Rosa Rodríguez-Rodríguez 2
- Emilio González-Arnay 2
- Carmen Nieves Pérez Brito 3
- Iballa JiménezCabrera 1
- Emilio González-Reimers 1
- 1 Servicio de Medicina Interna. Hospital Universitario de Canarias. Universidad de La Laguna (ESP)
- 2 Departamento de Anatomía y Anatomía Patológica. Hospital Universitario de Canarias. Universidad de La Laguna (ESP)
- 3 Servicio de Resonancia Magnética (IMETISA). Hospital Universitario de Canarias. Universidad de La Laguna (ESP)
ISSN: 1697-5529
Year of publication: 2016
Issue: 12
Pages: 22-27
Type: Article
More publications in: Majorensis: Revista Electrónica de Ciencia y Tecnología
Abstract
Primary central nervous system lymphoma is a nonHodgkin B-cell lymphoma that affects the brain or spinal cord without evidence of systemic disease. Its main risk factor is immunodeficiency such as HIV/AIDS, but over the past few years it is becoming increasingly more common among immunocompetent aged patients. A 73-year-old woman with a history of breast cancer in complete remission presented with disorientation, dyspnea and a history of falls. A chest CT was performed, revealing a pulmonary embolism. She was admitted to our unit and received anticoagulant therapy. Two days later she presented acute altered mental status and right hemiparesis. An urgent CT brain scan was requested, which showed multiple hypodense lesions. Given the previous history of cancer, brain metastases were suspected and the patient was placed on corticosteroid treatment, followed by a remarkable clinical improvement. A brain MRI showed several areas of altered signal with pathological contrast enhancement. The spectroscopic study was strongly suggestive of primary brain lymphoma. HIV serologic tests were negative. Steroid therapy was discontinued in order to perform a brain biopsy, with the histopathologic examination confirming the diagnosis of a primary brain lymphoma. After corticosteroid discontinuation, the patient suffered a noticeable clinical deterioration, with little to no response to its reintroduction, and she finally died. This case, of atypical clinical presentation, highlights the importance of considering this diagnosis even in immunocompetent patients, and underlines the fact that corticosteroids should be avoided or used at the smallest effective dose, as they can reduce biopsy sensitivity.