Diagnóstico de linfoma cerebral primario por el oftalmólogo

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Abstract

Caso clínico: Paciente varón de 20 años, VIH positivo, con miodesopsias en ambos ojos de 2 semanas de evolución. El examen fundoscópico reveló edema de papila bilateral con hemorragias peripapilares en llama. El estudio de neuroimagen mostró la presencia de una masa cerebral en el lóbulo parietal izquierdo. La biopsia confirmó el diagnóstico de neoplasia de estirpe linfoide. Discusión: El linfoma primario es la neoplasia más frecuente del sistema nervioso central (SNC) en pacientes con sida (síndrome de inmudeficiencia adquirida) aunque la terapia antirretroviral de gran actividad ha disminuido su incidencia. Destacamos el papel del oftalmólogo en el diagnóstico de neoplasias del SNC.

Translated abstract

Case report: A 20-year-old male, HIV positive, with myodesopsias (floaters) in both eyes for two weeks. Fundus examination revealed bilateral papillary oedema with peripapilar flame-shaped haemorrhages. The neuroimaging tests showed a cerebral mass in the left parietal lobe. The biopsy confirmed the diagnosis of lymphoid neoplasm. Discussion: Primary lymphoma is the most common malignancy of the central nervous system (CNS) in AIDS patients, although highly active antiretroviral therapy has reduced its incidence. The ophthalmologist plays an essential role in the diagnosis of CNS neoplasm.

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Most cited references 6

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Clinical aspects and management of AIDS-related lymphoma.

J A Sparano (2001)

The incidence of non-Hodgkin's lymphoma (NHL) is increased by approximately 100-fold in patients with advanced HIV infection. Clinical presentations may include systemic lymphoma, primary central nervous system (CNS) lymphoma, and primary effusion lymphoma. Systemic lymphoma is the most common presentation, is almost always of intermediate or high-grade histology and B-cell phenotype, and usually involves extranodal sites. The disease is potentially curable with combination chemotherapy used for immunocompetent patients with lymphoma, although cure is achieved in only approximately 10-35% of patients. Primary CNS lymphoma may be difficult to distinguish from cerebral infection. The prognosis is very poor, although approximately 10% of patients selected for therapy may survive beyond 1 year with brain irradiation. Attention to infection prophylaxis and antiretroviral therapy is important. Evidence suggests that highly active antiretroviral therapy (HAART) has resulted in a decreased incidence of lymphoma, and that patients with systemic lymphoma treated in the post-HAART era have a better prognosis.