[Potent primary leptomeningeal lymphoma masquerading as tuberculous meningitis - a case report].
A 45-year-old man presented with fever, progressive mutism and memory loss, was admitted to our hospital. MR imaging and angiography suggested multiple foci of infarctions and vasculitis without Gadrinium-enhancement. CSF examination revealed pleocytosis with mononuclear cell dominance and elevated protein content. Adenosine deaminase activity was accelerated, and no malignant cell was found. Whole body CT imaging and Garium-scintigraphy were normal. Under the clinical diagnosis of tuberculous meningitis, anti-tubercular drugs with steroid were administered, resulting in marked attenuation of his neurological impairments. Four months later, his symptoms aggravated and restudy of Garium-scintigraphy revealed enhanced accumulation in the submandibular and abdominal lymphnodes. A lymph node biopsy revealed diffuse large B-cell lymphoma cells. In such a case of this clinical statue, careful and repeated observations should be required to establish the correct diagnosis of occult lymphoma.
Department of Neurology, Aichi Medical University.
Soutarou
S
Taguchi
Jun-ichi
J
Niwa
Keisuke
K
Tokui
Tomoko
T
Nishikawa
Yuko
Y
Ichikawa
Manabu
M
Doyu
D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D006801:Humans; D007964:Leukocytosis / Q000175:diagnosis / Q000209:etiology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D014390:Tuberculosis, Meningeal; D014657:Vasculitis / Q000175:diagnosis / Q000209:etiology