Hammett RJ, Smith AI, Parkin D, Pigott P, Herkes G, Evans W; Australasian Society for HIV Medicine. Conference.
Annu Conf Australas Soc HIV Med. 1994 Nov 3-6; 6: 213 (unnumbered abstract).
HIV Medicine Unit, Royal North Shore Hospital, University of Sydney, St. Leonards, N.S.W.
We present the case report and post-mortem findings of a 31 year old HIV positive male who died of cerebral Lymphomatoid Granulomatosis. The patient was diagnosed as HIV positive in November 1989. An episode of Pneumocystis pneumonia in 1991 was his AIDS defining illness. In June 1992 his CD4 count was 50 x 1000/ul. He had been on Zidovudine 500 mg per day for eleven months. In July 1992 he presented with a one week history of right-sided headache, confusion, irritability and behavioural changes; associated with a 2 day history of nausea, vomiting and a rash on his forehead. On initial examination he had a temperature of 38.5 degrees C but had no signs of meningism. There was mild non-tender inguinal lymphadenopathy but physical examination was otherwise normal. His white cell count was 4.0 x 1000/ul, haemoglobin 12.1 g/dl and platelets 116 x 1000/ul. Electrolytes and liver function tests were normal, as were a chest X-ray and arterial blood gases. CT scan of the brain showed only mild non-specific changes. Lumbar puncture revealed a CSF pressure of 19.5 mm of water, glucose of 1.2 mmol/l, and protein of 3.02 g/dl. There were 30 polymorphonucleocytes, 87 monocytes, 94 red cells, and 8 unclassifieds. No organisms were seen and Cryptococcal antigen was negative. A presumptive diagnosis of Herpes encephalitis was made and treatment commenced with intravenous acyclovir and ceftriaxone. The patient's condition deteriorated over the next 48 hours with signs of meningism, and confusion. Anti-tuberculous and anti-fungal therapy were added to the treatment regimen but the patient did not respond and died six days after admission. A post-mortem showed lymphomatoid granulomatosis/angiocentric lymphoma in the brain, lungs and bone marrow. This case of fulminant lymphomatoid granulomatosis adds to the list of differential diagnoses in an AIDS patient with an acute neurological presentation.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Brain
- CD4 Lymphocyte Count
- Confusion
- Diagnosis, Differential
- Encephalitis, Herpes Simplex
- HIV Seropositivity
- Headache
- Humans
- Lymphomatoid Granulomatosis
- Male
- Meningism
- Meningitis
- Pneumonia, Pneumocystis
- Spinal Puncture
- Tomography, X-Ray Computed
- radiography
Other ID:
UI: 102212337
From Meeting Abstracts