title: Primary CNS lymphoma in a patient treated with azathioprine.
abstract: A 33-year-old man treated with azathioprine for 12 years for Crohn's disease presented with headache, nausea and vomiting accompanied by difficulty in putting words together and slight mental confusion. Prednisolone and antibiotics were without effect. MRI of the brain showed multiple focal lesions with surrounding oedema. There was cerebrospinal fluid pleocytosis, and Epstein-Barr virus (EBV) DNA was detected in the spinal fluid by PCR. A brain biopsy confirmed the suspicion of primary brain lymphoma. EBV-associated primary brain lymphoma is a relevant differential diagnosis in patients with long-standing immune suppression presenting with neurological symptoms. Detection of EBV DNA in the spinal fluid together with characteristic radiological findings may serve as a diagnostic clue for a quick diagnosis.
authors.affiliation: Department of Infectious Disease, Odense University Hospital, Odense, Denmark.
authors.forename: Matilde Kanstrup
authors.initials: MK
authors.lastname: Glesner
authors.affiliation: Department of Hematological Disease, Odense University Hospital, Odense, Denmark.
authors.forename: Lukas Frans
authors.initials: LF
authors.lastname: Ocias
authors.affiliation: Department of Hematological Disease, Odense University Hospital, Odense, Denmark.
authors.forename: Thomas Stauffer
authors.initials: TS
authors.lastname: Larsen
authors.affiliation: Department of Infectious Disease, Odense University Hospital, Odense, Denmark.
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D001706:Biopsy; D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis* / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine