Linfoma cerebral primario en una paciente inmunocompetentepresentación de un caso y revisión de la literatura

  1. Daniel Martínez Martínez 1
  2. Jacobo García Fernández 1
  3. Taysa Benítez Delgado 1
  4. Rosa Nieves Rodríguez Rodríguez 1
  5. Emilio González Arnay 1
  6. Carmen Nieves Pérez Brito 1
  7. Iballa Jiménez Cabrera 1
  8. Carlos Emilio González Reimers 1
  1. 1 Hospital Universitario de Canarias
    info

    Hospital Universitario de Canarias

    San Cristóbal de La Laguna, España

    ROR https://ror.org/05qndj312

Revista:
Majorensis: Revista Electrónica de Ciencia y Tecnología

ISSN: 1697-5529

Año de publicación: 2016

Número: 12

Páginas: 22-27

Tipo: Artículo

Resumen

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.