Primary Cerebral Lymphoma Causing Remitting and Relapsing Neurological Symptoms

Abstract

Primary CNS lymphoma is a rare variant of non-Hodgkins lymphoma. Incidence has increased over the past 3 decades, but the optimum treatment protocol is yet to be established. We report a 44-year old man who presented with left-sided numbness. Magnetic resonance imaging of the brain revealed a right hemisphere ill-defined mass. Within four months the patient experienced a spontaneous near-full recovery. From this time the patient deteriorated with increasing left hemiparesis. After several months, the patient developed lethargy and dyspnoea, with episodes of epistaxis and per rectal bleeding. Full blood count revealed a pancytopaenia. Trephine biopsy demonstrated evidence of marrow involvement by diffuse large B-cell lymphoma. The patient was diagnosed with primary CNS lymphoma with systemic involvement. We conclude that the spontaneous remission of symptoms should not discourage a diagnosis of PCNSL if consistent with clinical and radiological findings.




J Med Cases. 2013;4(6):420-423
doi: https://doi.org/10.4021/jmc1159e