Recovery from coma caused by primary CNS mantle cell lymphoma presenting as encephalitis

Although increasing frequency is reported, primary CNS lymphoma (PCNSL) is rare in immunocompetent patients. ^[1,2] Because of their ambiguous clinical, neuroradiographic, and CSF cytology, PCNSLs can be misdiagnosed. With diagnosis, appropriate treatment can lead to dramatic improvement, even if the patient is in a moribund state, as in the following case report.

Case report.

A 74-year-old woman was admitted to the hospital because of diffuse headache, vertigo, dysarthria, fatigue, anorexia, and intermittent but slowly progressive disorientation, confusion, and personality change beginning 4 weeks earlier. On admission the patient was alert, but memory function and concentration were below average. The neck was supple. The patient was afebrile. The erythrocyte sedimentation rate was 26/34 mm. Blood chemical and hematologic values were normal.

EEG showed generalized theta/delta activity with frontal accentuation and predominance in the left hemisphere. A precontrast CT scan of the brain disclosed blurred, hypodense, bifrontoparietal areas without surrounding hypodensity or mass effect and with ependymal thickening. After contrast, no uptake appeared in the hypodensity, but subependymal foci of contrast enhancement in both lateral ventricles and a subarachnoidal enhancement of the parietal regions were found Figure 1. Findings were interpreted as being suggestive of meningoencephalitis and ventriculitis. A plane and gadolinium brain MRI scan gave no additional information.

The first lumbar puncture on the seventh hospital day showed pleocytosis, increased total protein level, and reduced glucose Table 1. Cytologic …