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AIDS-related lymphoma (ARL) presenting as cauda equina syndrome.

Burkitt and Burkitt-like lymphomas account for 3% of AIDS-defining malignancies. Potentially involving any organ system, Burkitt (-like) lymphoma at presentation rarely compresses the lumbo-sacral spine/cauda equina. We describe ARL in an HIV-positive patient without history of AIDS-defining disease presenting as cauda equina syndrome cauda equina syndrome Acute cauda equina syndrome Neurosurgery
A condition caused by compression of multiple lumbosacral nerve roots in the spinal canal due to an abrupt prolapse of the lumbar disk Clinical CES is a medical emergency
. A 49-year-old male with stable human immunodeficiency virus human immunodeficiency virus

Human immunodeficiency virus (HIV)
A transmissible retrovirus that causes AIDS in humans.
 (HIV) infection for 11 years presented with lower extremity weakness and pain unrelieved with high dose oral aspirin, and incontinence of both bowel and bladder. Recently taken off highly active antiretroviral therapy Noun 1. highly active antiretroviral therapy - a combination of protease inhibitors taken with reverse transcriptase inhibitors; used in treating AIDS and HIV
drug cocktail, HAART
 (HAART HAART highly active antiretroviral therapy.
HAART Highly active antiretroviral therapy, triple combination therapy AIDS The concurrent administration of 2 nucleoside reverse transcriptase inhibitors–eg, AZT and 3TC, and a protease
) for a dermatologic reaction, he had never experienced an opportunistic infection or AIDS-defining illness; his last CD4+ cell count was 421/[micro]L, HIV viral load HIV viral load AIDS A measure of the amount of HIV RNA in blood, expressed as number of copies/mL of plasma. See AIDS, HIV.  was 93/[micro]L. His exam revealed bilateral lower extremity weakness and hyporeflexia with intact sensation, and saddle anesthesia with absence of rectal tone. MRI revealed a presacral mass invading the lumbosacral canal. Intravenous dexamethasone, a four-drug antituberculous regimen, and broad-spectrum antibiotics were begun empirically. After a nondiagnostic CT-guided biopsy, laminectomy laminectomy /lam·i·nec·to·my/ (lam?i-nek´tah-me) excision of the posterior arch of a vertebra.

Excision of a vertebral lamina. Also called rachiotomy.
 and biopsy of an epidural mass showed small blue cells with noncleaved nuclei. Pathology confirmed the "starry sky" appearance of Burkitt or Burkitt-like lymphoma. Bone marrow was negative for lymphomatous involvement. Spinal radiotherapy was begun, HAART was restarted, and oncology was consulted. Patients who are HIV-positive are several hundred times more likely to develop a NHL than HIV-negative patients. Unlike diffuse high grade B cell lymphoma, Burkitt (-like) lymphoma often develops at relatively high CD4+ cell counts. Eighty percent of patients present with stage four disease and most develop extranodal spread occasionally involving the leptomeninges leptomeninges /lep·to·me·nin·ges/ (lep?to-me-nin´jez) sing. leptome´ninx   the pia mater and arachnoid taken together; the pia-arachnoid.leptomenin´geal

. However, it rarely exists as a solitary extramedullary compressive mass. No other published case has been found describing Burkitt (-like) ARL presenting as cauda equina syndrome.

Robert Holmes, DO, Jason Tompkins, MD, and Ruth Berggren, MD. Keesler Medical Center, Keesler AFB, MS. Charity Hospital, New Orleans, LA.
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Title Annotation:Section on Oncology
Author:Berggren, Ruth
Publication:Southern Medical Journal
Date:Oct 1, 2004
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