Long-term remission of AIDS-related primary central nervous system lymphoma in a patient under antiretroviral therapy: a case report and review of the literature.

Details

Serval ID
serval:BIB_577605188D0D
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
Long-term remission of AIDS-related primary central nervous system lymphoma in a patient under antiretroviral therapy: a case report and review of the literature.
Journal
AIDS research and therapy
Author(s)
Gijs P.J., Clerc O.
ISSN
1742-6405 (Electronic)
ISSN-L
1742-6405
Publication state
Published
Issued date
19/10/2021
Peer-reviewed
Oui
Volume
18
Number
1
Pages
76
Language
english
Notes
Publication types: Case Reports ; Journal Article ; Review
Publication Status: epublish
Abstract
AIDS-related primary central nervous system lymphoma (AR-PCNSL) is an AIDS-defining disease that usually occurs when the CD4 count is less than 50 cells/μl. The frequency of the disease has substantially decreased in the era of highly active antiretroviral therapy (HAART). Prognosis is poor with rapid progression leading to death within 2-3 months if left untreated.
A 65 years old male presented to medical attention with gait disturbance, weight loss and slight left-sided hemiparesis. Human immunodeficiency virus infection was diagnosed with an initial CD4 count of 116 cells/µl and a viral load of 260,000 copies/ml. Magnetic resonance imaging of the brain revealed three brain lesions involving the right frontal lobe and the left parietal lobe, which on biopsy led to a diagnosis of AR-PCNSL. HAART was initiated with whole-brain radiotherapy (WBRT), and the patient declined systemic chemotherapy. Due to poor performance status, he was transferred to palliative care. Under HAART, he slowly recovered with normalization of CD4 count and undetectable viral load. Medical imaging showed complete remission (CR) of the brain lesions. At 3-year follow-up, the patient remains in CR, but presented mild neurocognitive dysfunction possibly secondary to WBRT.
Nowadays, treatment paradigm parallels that of primary central nervous system lymphoma in the immunocompetent population based on systemic chemotherapy (primarily high-dose intravenous methotrexate and steroids) in association with HAART. The role of WBRT is questionable because of late neurotoxic effects.
Keywords
Acquired Immunodeficiency Syndrome, Aged, Antiretroviral Therapy, Highly Active, Central Nervous System, Central Nervous System Neoplasms/drug therapy, HIV Infections/drug therapy, Humans, Lymphoma, AIDS-Related/drug therapy, Male, Acquired immunodeficiency syndrome, Antiretroviral therapy, Primary central nervous system lymphoma, Whole-brain radiotherapy
Pubmed
Web of science
Open Access
Yes
Create date
25/10/2021 9:20
Last modification date
24/02/2022 7:33
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