Abstract
Background:
Acquired immunodeficiency syndrome (AIDS), stemming from human immunodeficiency virus (HIV) infection, persists as a global concern, despite decreased prevalence due to enhanced therapy and preventive measures. Primary central nervous system lymphoma (PCNSL), a non-Hodgkin lymphoma, necessitates prompt brain imaging. However, nonspecific symptoms can lead to delayed diagnosis. Herein, we present a case of HIV-associated primary CNS lymphoma (HIV-PCNSL) characterized by atypical clinical presentation and laboratory findings.
Case presentation:
We report a case of a 36-year-old male with no medical history presenting with symptoms including fatigue, left leg weakness, hypoglycemia, and loss of consciousness. Diagnostic evaluations revealed multifocal low-density brain changes and the presence of nontyphoidal Salmonella in blood cultures. Subsequent investigations confirmed acquired immunodeficiency syndrome (AIDS) with concurrent human immunodeficiency virus (HIV) infection. Clinical manifestations and laboratory results suggested panhypopituitarism. A stereotactic brain biopsy confirmed primary central nervous system lymphoma (PCNSL). The patient underwent a comprehensive treatment regimen involving Rituximab and high-dose methotrexate for lymphoma, highly active antiretroviral therapy (HAART) for HIV, and hormone replacement therapy for secondary adrenal insufficiency. This integrated approach resulted in tumor size reduction and overall clinical improvement.
Conclusions:
AIDS may manifest with diverse symptoms, particularly when neurological deficits are evident, prompting consideration of opportunistic brain infections or malignancies. Our case presentation elucidates the clinical rationale and diagnostic trajectory for detecting AIDS in a young man with hypoglycemia and left leg weakness. This underscores not only the atypical manifestations and differential diagnosis of brain lesions in AIDS patients but also advocates for a comprehensive approach.