Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Potent primary leptomeningeal lymphoma masquerading tuberculous meningitis-A case report

Soutarou Taguchi, M.D., Jun-ichi Niwa, M.D., Ph.D., Keisuke Tokui, M.D., Ph.D., Tomoko Nishikawa, M.D., Yuko Ichikawa, M.D. and Manabu Doyu, M.D., Ph.D.

Department of Neurology, Aichi Medical University

A 45-year-old man presented with fever, progressive mutism and memory loss, was admitted to our hospital. MR imaging and angiography suggested multiple foci of infarctions and vasculitis without Gadriniumenhancement. CSF examination revealed pleocytosis with mononuclear cell dominance and elevated protein content. Adenosine deaminase activity was accelerated, and no malignant cell was found. Whole body CT imaging and Garium-scintigraphy were normal. Under the clinical diagnosis of tuberculous meningitis, anti-tubercular drugs with steroid were administered, resulting in marked attenuation of his neurological impairments. Four months later, his symptoms aggravated and restudy of Garium-scintigraphy revealed enhanced accumulation in the submandibular and abdominal lymphnodes. A lymph node biopsy revealed diffuse large B-cell lymphoma cells. In such a case of this clinical statue, careful and repeated observations should be required to establish the correct diagnosis of occult lymphoma.
Full Text of this Article in PDF (526K)

(CLINICA NEUROL, 52: 416|420, 2012)
key words: primary leptomeningeal lymphoma, tuberculous meningitis, cerebral infarction, vasculitis, lymphadenopathy

(Received: 7-Dec-11)