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When Zoster Virus Hides a Primary Brain Lymphoma

2019Journal article Open access
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dc.contributor.authorNascimento, Rafael Ferreira
dc.contributor.authorFreitas, João Miguel
dc.contributor.authorBrazão, Maria Da Luz
dc.date.accessioned2020-11-06T13:00:45Z
dc.date.available2020-11-06T13:00:45Z
dc.date.issued2019
dc.description.abstractTo describe an unusual presentation of a primary lymphoma of the central nervous system in a patient who, four months prior to admission, was diagnosed with herpes zoster ophthalmicus (HZO). Case description: A 68-year-old man, with a history of HZO, was admitted to the emergency department with nausea and vomiting that had persisted over the previous two weeks. Neurological evaluation showed right ptosis, divergent strabismus and anisocoria. Blood tests showed high c-reactive protein, while serology was negative for human immunodeficiency virus. A brain CT scan revealed three round lesions, slightly hyperdense, periventricular in the occipital and frontal regions, which biopsy revealed to be a diffuse large B-cell lymphoma. The patient started chemotherapy but progression to death was inevitable. Conclusion: The authors describe an unusual presentation of primary lymphoma of the central nervous system and urge physicians to be aware of this presentation in order to avoid misdiagnosis.pt_PT
dc.description.abstractCASE DESCRIPTION A 68-year-old Caucasian male was asymptomatic until two weeks before admission to the emergency department, when he developed nausea and vomiting, which persisted despite antiemetic medication. Other than a diagnosis of right-sided herpes zoster ophthalmicus (HZO), four months before admission, and type 2 diabetes, his past medical history was unremarkable. General examination on admission was normal but neurological examination revealed right ptosis, divergent strabismus and anisocoria. Blood tests revealed normocytic normochromia anaemia with Hb 10.2, VGM 86 fl, leucocytes 5,100×109/l, thrombocytopenia with a platelet count of 91,000×109/l and a C-reactive protein level of 61.5 mg/l (normal <3 mg/l). A CT scan of the brain to rule out stroke surprisingly showed three round lesions, slightly hyperdense, with intra-axial and periventricular location (Fig.1). Cerebrospinal fluid collected by lumbar puncture was acellular with normal protein and glucose levels, ruling out a CNS infection. Autoimmune study and serological tests, including tests for human immunodeficiency virus (HIV), hepatitis virus, syphilis and Epstein-Barr virus, were negative.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationFerreira Nascimento R, Freitas JM, Luz Brazão M. When Zoster virus hides a primary brain lymphoma. EJCRIM 2019;6:pt_PT
dc.identifier.doi10.12890/2019_001341pt_PT
dc.identifier.issn2284-2594
dc.identifier.urihttp://hdl.handle.net/10400.26/33938
dc.language.isoengpt_PT
dc.publisherEFIM- Official Journal of Internal Medicinept_PT
dc.subjectImmunocompetent, lymphomapt_PT
dc.subjectcentral nervous system,pt_PT
dc.subjectZoster viruspt_PT
dc.subject;Madeira Islandpt_PT
dc.titleWhen Zoster Virus Hides a Primary Brain Lymphomapt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue12pt_PT
oaire.citation.startPage001341pt_PT
oaire.citation.titleEuropean journal of case reports in internal medicinept_PT
oaire.citation.volume6pt_PT
person.familyNameBrazão
person.givenNameMaria da Luz
person.identifier.orcid0000-0002-2584-1573
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication40b4a06e-d94f-4041-8377-3120e0aaefa7
relation.isAuthorOfPublication.latestForDiscovery40b4a06e-d94f-4041-8377-3120e0aaefa7

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