title: Burkitt's non-Hodgkins lymphoma presenting as facial nerve palsy in HIV-positive patients.
abstract: An isolated facial nerve palsy is rare as the presentation of a central nervous system lymphoma. In this case series, we present the clinical features of three HIV-positive patients presenting with facial nerve palsies due to HIV-associated Burkitt's lymphoma. These patients had a non-resolving facial paralysis, which occurred during a late stage of HIV. Magnetic resonance imaging (MRI) did not show leptomeningeal enhancement. Cerebrospinal fluid revealed a lymphocytosis with elevated protein and low glucose levels. The diagnosis of Burkitt's lymphoma was made on histology which showed the characteristic 'starry sky' appearance due to scattered tangible body-laden macrophages. The patients were commenced on the intensive chemotherapy regimen of CODOX-M/IVAC. Two patients died of disease progression and the third patient died of chemotherapy toxicity. This case series highlights the need for a high index of suspicion for underlying malignancy when a patient presents with a persistent facial paralysis in the later stages of HIV infection.
authors.affiliation: Chelsea and Westminster Hospital, St Stephen's Centre, London, UK. hannahwoodcock@doctors.org.uk
authors.forename: H
authors.initials: H
authors.lastname: Woodcock
authors.forename: M
authors.initials: M
authors.lastname: Nelson
mesh_terms: D000328:Adult; D002051:Burkitt Lymphoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D016543:Central Nervous System Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D002555:Cerebrospinal Fluid / Q000737:chemistry / Q000166:cytology; D005154:Facial Nerve / Q000503:physiopathology*; D015658:HIV Infections / Q000150:complications*; D006257:Head / Q000000981:diagnostic imaging; D006651:Histocytochemistry; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D010243:Paralysis / Q000175:diagnosis*; D011859:Radiography