CRANIAL NEUROPATHY HERALDING OTHERWISE OCCULT AIDS-RELATED LARGE-CELLLYMPHOMA

Three HIV-infected patients developed cranial neuropathy as the initia l manifestation of an AIDS-related large cell lymphoma. All were homos exual men known to be HIV seropositive for 3 to 4.5 years. At the time of presentation for neurological disease, the CD4 T-lymphocyte count was <400 cells/mm3 in each. Initial manifestations were retro-orbital headache and oculomotor nerve palsy in two and an abducens nerve palsy in the other. Repeatedly negative CSF cytologies and recovery of the cranial neuropathy obscured the diagnosis. These patients illustrate t hat cranial neuropathy with HIV infection may herald the presence of a n occult large cell lymphoma. Spontaneous or corticosteroid-associated improvement of the cranial neuropathy, absence of abnormalities on br ain imaging studies, and negative CSF cytologies do not exclude this d iagnosis. We suggest that a diligent and repeated search for lymphoma be considered in HIV-infected patients presenting with cranial neuropa thy, including repeated CSF examinations, MRI of brain and spine (T1 a nd T2) with and without gadolinium enhancement, chest and abdominal CT scans, and bone marrow biopsy.