A 20-year-old male referred myodesopsias in both eyes (OA) of 2 weeks duration.
Personal history: HIV positive, untreated and pending assessment by the Internal Medicine Department (IM).
Visual acuity was 20/20 in BE.
The intrinsic motility test was normal.
Biomicroscopy of the anterior segment revealed no significant findings and intraocular pressure was 16 mmHg in BE.
Funduscopic examination revealed bilateral papilledema with peripapular hemorrhages in flame, with no foci of colitis or vasculitis.
Diagnosis of intracranial hypertension was suspected and imaging tests were requested.
Computed tomography (CT) of the brain showed the presence of a mass in the left parietal lobe surrounded by an intense vasogenic edema that caused subfacial and transtentorial right descending herniation.
Empirical antitoxoplasma treatment was initiated and dexamethasone was administered at high doses, improving the patient's clinical status.
CD4 count was equal to 20/μl and antitoxoplasma IgG determinations were negative.
Subsequently, a control nuclear magnetic resonance (NMR) was performed, which showed a solid 4 x 4 cm mass in the left parietal lobe.
Brain biopsy confirmed the diagnosis of lymphoid neoplasm.
