Primary large B-cell lymphoma of the central nervous system misdiagnosed as autoimmune encephalitis: a case report
Primary central nervous system lymphomas (PCNSL) are rare, constituting 2 - 3% of intracranial malignancies. A 49-year-old male presented with a 20-day history of dizziness and a 15-day history of right-sided weakness. Physical examination revealed various abnormal signs. Initial cerebrospinal fluid...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2024.1465961/full |
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| author | Aihui Ren Guanwen Zeng Riling Chen Zhixing Cao Wenyan Zhuo Yubin Liang Yubin Liang |
| author_facet | Aihui Ren Guanwen Zeng Riling Chen Zhixing Cao Wenyan Zhuo Yubin Liang Yubin Liang |
| author_sort | Aihui Ren |
| collection | DOAJ |
| description | Primary central nervous system lymphomas (PCNSL) are rare, constituting 2 - 3% of intracranial malignancies. A 49-year-old male presented with a 20-day history of dizziness and a 15-day history of right-sided weakness. Physical examination revealed various abnormal signs. Initial cerebrospinal fluid (CSF) analysis was unremarkable, while MRI scans (both plain and contrast-enhanced) showed abnormal signals in the left brainstem, thalamus, and basal ganglia regions, with specific enhancement patterns, and arterial spin labeling (ASL) demonstrated hyperperfusion. The patient was initially diagnosed with autoimmune encephalitis (AE) and treated with methylprednisolone with dose reduction and subsequent discharge. However, two months later, his condition deteriorated. Re-evaluation of MRI data, along with magnetic resonance spectroscopy (MRS) results, suggested a neoplastic process. A stereotactic brain biopsy led to a PCNSL diagnosis. The patient was then transferred for high-dose methotrexate chemotherapy but due to lack of regular follow-up, the disease progressed, resulting in cerebral herniation and respiratory failure and ultimately death. The coexistence of PCNSL and AE is diagnostically difficult because of atypical clinical features and non-specific imaging. Thus, for patients with suspected CNS immune-mediated diseases who relapse after steroid treatment improvement, comprehensive evaluation including CSF examination, MRI, and prompt pathological examination is crucial to consider the possibility of PCNSL. |
| format | Article |
| id | doaj-art-9c49b02a74b74ebda1defa67fd73abcd |
| institution | Kabale University |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Oncology |
| spelling | doaj-art-9c49b02a74b74ebda1defa67fd73abcd2025-01-06T06:58:56ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-01-011410.3389/fonc.2024.14659611465961Primary large B-cell lymphoma of the central nervous system misdiagnosed as autoimmune encephalitis: a case reportAihui Ren0Guanwen Zeng1Riling Chen2Zhixing Cao3Wenyan Zhuo4Yubin Liang5Yubin Liang6Department of Neurology, Zhuhai Clinical Medical College of Jinan University (Zhuhai People’s Hospital), Zhuhai, ChinaDepartment of Neurology, Zhuhai Clinical Medical College of Jinan University (Zhuhai People’s Hospital), Zhuhai, ChinaDepartment of Neurology, Zhuhai Clinical Medical College of Jinan University (Zhuhai People’s Hospital), Zhuhai, ChinaDepartment of Neurology, Zhuhai Clinical Medical College of Jinan University (Zhuhai People’s Hospital), Zhuhai, ChinaDepartment of Neurology, Zhuhai Clinical Medical College of Jinan University (Zhuhai People’s Hospital), Zhuhai, ChinaDepartment of 2ndBrain Center and Stroke Center, The Affiliated Panyu Central Hospital, Guangzhou Medical University, Guangzhou, ChinaGeriatric Medicine Institute of Panyu District, The Affiliated Panyu Central Hospital, Guangzhou Medical University, Guangzhou, ChinaPrimary central nervous system lymphomas (PCNSL) are rare, constituting 2 - 3% of intracranial malignancies. A 49-year-old male presented with a 20-day history of dizziness and a 15-day history of right-sided weakness. Physical examination revealed various abnormal signs. Initial cerebrospinal fluid (CSF) analysis was unremarkable, while MRI scans (both plain and contrast-enhanced) showed abnormal signals in the left brainstem, thalamus, and basal ganglia regions, with specific enhancement patterns, and arterial spin labeling (ASL) demonstrated hyperperfusion. The patient was initially diagnosed with autoimmune encephalitis (AE) and treated with methylprednisolone with dose reduction and subsequent discharge. However, two months later, his condition deteriorated. Re-evaluation of MRI data, along with magnetic resonance spectroscopy (MRS) results, suggested a neoplastic process. A stereotactic brain biopsy led to a PCNSL diagnosis. The patient was then transferred for high-dose methotrexate chemotherapy but due to lack of regular follow-up, the disease progressed, resulting in cerebral herniation and respiratory failure and ultimately death. The coexistence of PCNSL and AE is diagnostically difficult because of atypical clinical features and non-specific imaging. Thus, for patients with suspected CNS immune-mediated diseases who relapse after steroid treatment improvement, comprehensive evaluation including CSF examination, MRI, and prompt pathological examination is crucial to consider the possibility of PCNSL.https://www.frontiersin.org/articles/10.3389/fonc.2024.1465961/fullCNSlymphomaautoimmune encephalitismisdiagnosiscase report |
| spellingShingle | Aihui Ren Guanwen Zeng Riling Chen Zhixing Cao Wenyan Zhuo Yubin Liang Yubin Liang Primary large B-cell lymphoma of the central nervous system misdiagnosed as autoimmune encephalitis: a case report Frontiers in Oncology CNS lymphoma autoimmune encephalitis misdiagnosis case report |
| title | Primary large B-cell lymphoma of the central nervous system misdiagnosed as autoimmune encephalitis: a case report |
| title_full | Primary large B-cell lymphoma of the central nervous system misdiagnosed as autoimmune encephalitis: a case report |
| title_fullStr | Primary large B-cell lymphoma of the central nervous system misdiagnosed as autoimmune encephalitis: a case report |
| title_full_unstemmed | Primary large B-cell lymphoma of the central nervous system misdiagnosed as autoimmune encephalitis: a case report |
| title_short | Primary large B-cell lymphoma of the central nervous system misdiagnosed as autoimmune encephalitis: a case report |
| title_sort | primary large b cell lymphoma of the central nervous system misdiagnosed as autoimmune encephalitis a case report |
| topic | CNS lymphoma autoimmune encephalitis misdiagnosis case report |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2024.1465961/full |
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