SHM Converge Scientific Abstract ePoster Gallery-Ptosis- An Unusual Presentation of an Aids-Defining Illness

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A 55-year-old woman with HIV on antiretroviral therapy presented with 3 days of right-sided ptosis, diplopia, fever, anorexia, and recent weight loss. Exam showed impaired right eye supraduction and adduction with otherwise normal pupils, visual fields, fundus, and left eye function. Laboratory studies revealed severe anemia, thrombocytopenia, acute kidney injury, markedly elevated LDH and uric acid, and a reduced CD4 count.  <br /><br />Because of the focal cranial nerve findings and hematologic abnormalities, neuro-ophthalmology, infectious disease, and oncology were consulted. CT imaging demonstrated diffuse lymphadenopathy and infiltrative soft tissue involving both renal sinuses, the pelvicalyceal systems, and the right ureter. Brain MRI showed diffuse pachymeningeal enhancement, asymmetric enhancement of the right hemipons, ventral brainstem involvement, and possible bilateral oculomotor nerve enhancement, without optic nerve or extraocular muscle disease.  <br /><br />Peripheral blood flow cytometry identified a small population of CD10-positive lambda-restricted B cells. Infectious and hemolytic workups were negative, though EBV viral load was mildly elevated. Bone marrow biopsy confirmed stage IV Burkitt lymphoma. The patient was started on EPOCH-R chemotherapy, and her ptosis fully resolved within 10 days.  <br /><br />The case emphasizes that in HIV-positive patients, new focal neurologic deficits such as ptosis should raise concern for CNS lymphoma, especially when accompanied by cytopenias and elevated LDH.

Asset Subtitle

Kyndal McKnight

Meta Tag

Author List Kyndal McKnight, Mayur Narkhede, Michael Vaphiades, Shashi K. Katukoori

Category Clinical Vignettes

Concept Burkitt Lymphoma

Concept Focal Neurologic Deficit

Concept Cranial Nerve Involvement

Concept Bicytopenia

Concept HIV-Associated Lymphoma

Distinguished Non-Finalist

Presenter Organization University of Alabama at Birmingham

Presenting Author Kyndal McKnight

Track Adult

Keywords

HIV

Burkitt lymphoma

ptosis

diplopia

cranial nerve palsy

pachymeningeal enhancement

brainstem involvement

CD10-positive B cells

cytopenias

EPOCH-R chemotherapy

Burkitt Lymphoma

Focal Neurologic Deficit

Cranial Nerve Involvement

Bicytopenia

HIV-Associated Lymphoma