SHM Converge Scientific Abstract ePoster Gallery-One for One: Ebv Positive Lymphoproliferative Brain Masses in Aids

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A 41-year-old woman with no prior medications presented with fever, witnessed seizures, and recurrent falls, requiring intubation and ICU admission. On examination, she was cachectic, lethargic, and had dark pigmented crusted skin lesions. Initial labs were largely normal, but lumbar puncture showed neutrophilic CSF pleocytosis with CMV PCR positivity. HIV testing revealed advanced AIDS with an HIV-1 viral load of 2,130,000 copies/mL and a CD4 count of 11.<br /><br />Brain MRI demonstrated heterogeneously enhancing mass-like lesions in the bilateral frontal lobes and right basal ganglia, with mild meningeal enhancement and a small ischemic focus. Because the imaging findings were atypical for CMV encephalitis, a stereotactic brain biopsy was performed. Pathology showed a patchy atypical lymphoid infiltrate with small lymphocytes and monocytes, findings that ruled out primary CNS lymphoma and favored a polymorphic EBV-positive B-cell lymphoproliferative disorder. EBV in-situ hybridization was positive, confirming an HIV-associated lymphoproliferative process.<br /><br />This case highlights that CMV detection in cerebrospinal fluid is not always definitive in patients with AIDS and can coexist with or distract from another underlying diagnosis. The combination of neuroimaging, CSF studies, and tissue biopsy was essential to identify the true cause of the brain masses. The report emphasizes the importance of considering EBV-associated lymphoproliferative disorders in advanced HIV, as these lesions may mimic infection or lymphoma and carry significant morbidity and mortality if untreated.

Asset Subtitle

Prasanthi Limgala

Meta Tag

Author List Anand Reddy Maligireddy, Paula McKenzie, Prasanthi Limgala, Roop Sunil Reddy Parlapalli

Category Clinical Vignettes

Concept HIV/AIDS

Concept Mass Lesion

Concept B-Cell Lymphoproliferative Disorder

Concept Neurologic Symptoms

Concept Altered Mental Status

Distinguished Non-Finalist

Presenter Organization Geisinger Health System

Presenting Author Prasanthi Limgala

Track Adult

Keywords

AIDS

CMV encephalitis

EBV-positive B-cell lymphoproliferative disorder

brain mass lesions

HIV-associated CNS disease

stereotactic brain biopsy

CSF pleocytosis

advanced HIV infection

primary CNS lymphoma differential

neuroimaging

HIV/AIDS

Mass Lesion

B-Cell Lymphoproliferative Disorder

Neurologic Symptoms

Altered Mental Status