Document 0295
 DOCN  M9590295
 TI    Fulminant lymphomatoid granulomatosis presenting as meningitis--a case
       report.
 DT    9509
 AU    Hammett RJ; Smith AI; Parkin D; Pigott P; Herkes G; Evans W; HIV
       Medicine Unit, Royal North Shore Hospital, University of; Sydney, St.
       Leonards, N.S.W.
 SO    Annu Conf Australas Soc HIV Med. 1994 Nov 3-6;6:213 (unnumbered
       abstract). Unique Identifier : AIDSLINE ASHM6/95291804
 AB    We present the case report and post-mortem findings of a 31 year old HIV
       positive male who died of cerebral Lymphomatoid Granulomatosis. The
       patient was diagnosed as HIV positive in November 1989. An episode of
       Pneumocystis pneumonia in 1991 was his AIDS defining illness. In June
       1992 his CD4 count was 50 x 1000/ul. He had been on Zidovudine 500 mg
       per day for eleven months. In July 1992 he presented with a one week
       history of right-sided headache, confusion, irritability and behavioural
       changes; associated with a 2 day history of nausea, vomiting and a rash
       on his forehead. On initial examination he had a temperature of 38.5
       degrees C but had no signs of meningism. There was mild non-tender
       inguinal lymphadenopathy but physical examination was otherwise normal.
       His white cell count was 4.0 x 1000/ul, haemoglobin 12.1 g/dl and
       platelets 116 x 1000/ul. Electrolytes and liver function tests were
       normal, as were a chest X-ray and arterial blood gases. CT scan of the
       brain showed only mild non-specific changes. Lumbar puncture revealed a
       CSF pressure of 19.5 mm of water, glucose of 1.2 mmol/l, and protein of
       3.02 g/dl. There were 30 polymorphonucleocytes, 87 monocytes, 94 red
       cells, and 8 unclassifieds. No organisms were seen and Cryptococcal
       antigen was negative. A presumptive diagnosis of Herpes encephalitis was
       made and treatment commenced with intravenous acyclovir and ceftriaxone.
       The patient's condition deteriorated over the next 48 hours with signs
       of meningism, and confusion. Anti-tuberculous and anti-fungal therapy
       were added to the treatment regimen but the patient did not respond and
       died six days after admission. A post-mortem showed lymphomatoid
       granulomatosis/angiocentric lymphoma in the brain, lungs and bone
       marrow. This case of fulminant lymphomatoid granulomatosis adds to the
       list of differential diagnoses in an AIDS patient with an acute
       neurological presentation.
 DE    Adult  Brain/PATHOLOGY  Brain Neoplasms/*PATHOLOGY  Diagnosis,
       Differential  Human  HIV Seropositivity/*PATHOLOGY  Lymphomatoid
       Granulomatosis/*PATHOLOGY  Male  Meningitis/*PATHOLOGY  Neurologic
       Examination  MEETING ABSTRACT

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