A 34-year-old man with a history of hepatitis B and HIV positive presented with decay, weight loss, chest pain and frontal behavior.
Lumbar puncture was negative for VDRL, toxoplasma and EBV (by PCR technique).
Pathological studies showed mild anemia with Hb of 10.3 g/dL (13.5-17.5 g/dL), hematocrit of 30% (41-4500mm/-53%), leucopenia ( 3,100mm/mm3) (500mm3).
LDH and C-reactive protein were within normal limits (133 U/L [1335-225 U/L] and 0.1 mg/dL [0-1 mg/dL], respectively).
The patient also had severe immunosuppression with a CD4 T lymphocyte count of 6.9/mm3.
Imaging studies revealed two cortico-subcortical nodules in the middle and right frontal zones with inflammatory aspect.
There was no pulmonary or other anatomical site involvement.
Stereotactic biopsy showed brain tissue with reactive gliosis and extensive mixed infiltrate, predominantly perivascular and areas with trophoblastic disease and angio-destruction composed of small lymphocytic angiolymphocytes CD3 (CD3).
In addition, abundant lymphoid cells with medium and large nuclei were identified, vesi-like and pleomorphic immunoreactive for CD20 (lymphocytes B).
Lymphocytes showed a positive reaction to EBV-associated small RNA sequence EBER-1 by in situ hybridization.
These cells showed negative reaction for CD30, CD68 and S-100 protein.
No microorganisms were identified in the biopsy with Gram stains, PAS, Ziehl-Neelsen and Warthin-Starry.
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The flow cytometry of brain tissue revealed the presence of intermediate cells of strain B with light chain restriction Kappa, suggesting a lymphoproliferative syndrome.
Myelogram and bone marrow biopsy were negative.
Overall, the findings were consistent with grade 3 cerebral LG (diffuse large B-cell lymphoma).
The case reported in this article was confirmed as HIV immunodeficiency syndrome stage C3 and antiretroviral therapy was initiated.
The patient subsequently requested transfer to another center for further management.
