Varicella-zoster viral meningitis mimicking lymphoma.
We report the case of a 30-year-old HIV-infected man admitted for a meningeal syndrome and a zoster rash. The CSF had cytological features suggesting a primary CNS lymphoma (PCNSL). The large lymphoid cells had a fine chromatin with nucleoli, a basophilic cytoplasm with azurophilic granules and high mitotic activity. Several arguments demonstrated the viral origin of the meningitis: the large lymphoid cells were of T origin with no evidence of clonal TCR gamma gene rearrangement. The PCR was positive for Varicella-Zoster Virus (VZV) and EBV DNA. Clinical evolution was favorable under acyclovir. We should be cautious in the differential diagnosis between viral meningitis and PCNSL.
Park
S
S
Laboratoire d'hématologie, Hôpital Saint-Louis, 1 av Claude Vellefaux, 75010 Paris, France. parksophie@yahoo.com
Leymarie
V
V
Agbalika
F
F
Galicier
L
L
Oksenhendler
E
E
Sigaux
F
F
Noguera
M E
ME
D000328:Adult; D016543:Central Nervous System Neoplasms / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000821:virology*; D004279:DNA, Viral / Q000134:cerebrospinal fluid; D003937:Diagnosis, Differential; D020031:Epstein-Barr Virus Infections / Q000134:cerebrospinal fluid / Q000821:virology; D015774:Ganciclovir / Q000627:therapeutic use; D006562:Herpes Zoster / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000503:physiopathology; D014645:Herpesvirus 3, Human / Q000302:isolation & purification / Q000472:pathogenicity*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000821:virology*; D008297:Male; D008587:Meningitis, Viral / Q000175:diagnosis*; D016133:Polymerase Chain Reaction
D004279:DNA, Viral; D015774:Ganciclovir