Orbital Plasmacytoma in a Young Patient With HIV Presenting as Multiple Cranial Nerve Palsy
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A 22-year-old man with HIV infection (CD4+ count 563/mm3 and HIV-1 load 186 copies/mL) presented with headache and left diplopia. On examination, ipsilateral proptosis with extraocular movement impairment in all directions was noted (Figure, A, and Video 1). Brain MRI revealed a diffuse pattern with an infiltrative left orbital lesion (Figure, B–D) and the subgaleal biopsy revealed plasmacytoma. HIV may act as a superantigen, triggering B-cell clonal expansion. However, there is little evidence to support the development of multiple myeloma.1,2 Plasma cell disorders are rare in patients with HIV; they tend to occur early in the course of infection and are clinically aggressive.
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Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received September 5, 2021.
- Accepted in final form February 17, 2022.
- © 2022 American Academy of Neurology
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