Lymphomatoid granulomatosis presenting as tinnitus in a patient with acquired immunodeficiency syndrome

Abstract

Listen

Translate article

Introduction: Puzzling neurologic symptoms in an immunosuppressed patient presents the clinician with a broad and challenging differential diagnosis. Multiple neurological complications in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)-infected individuals have been reported, the most common being cognitive dysfunction, infections, and malignancies. In patients with advanced immunosuppression any neurological symptom should be taken seriously. We report a case of Epstein–Barr virus (EBV) related lymphomatoid granulomatosis presenting in a patient with AIDS initially as tinnitus. Case Report: A 42-year-old female was presented to her physician complaining of tinnitus. Unbeknownst to her physician, she had been diagnosed with human immunodeficiency virus (HIV) 14 years prior. Her tinnitus led her to undergo a workup in outpatient clinic. However, her neurological symptoms gradually progressed to include hearing loss and diplopia. She was admitted to another hospital and underwent an extensive array of testing. Laboratory testing indicated that her HIV had progressed to AIDS. Neurological imaging revealed a brainstem lesion. She was transferred to our hospital when the brainstem lesion was deemed inaccessible by neurosurgery. Several small pulmonary nodules had been noted on computed tomography scan of her chest. Surgical biopsy with pathology and flow cytometry of a lung nodule showed EBV-related lymphomatoid granulomatosis. Soon after, a unifying diagnosis between her lung nodules and a central nervous system disease was made as flow cytometry of her cerebrospinal fluid showed an identical aberrant B cell population consistent with lymphomatoid granulomatosis with transformation to diffuse large B cell lymphoma. Unfortunately, patient's brainstem lesions progressed and patient died after a few weeks in the hospital. Conclusion: Epstein–Barr virus related lymphomatoid granulomatosis is a rare disease that can be the cause of unexplained neurological symptoms in immunocompromised individuals. We report a challenging case in which the diagnosis was only considered after lung biopsy of relatively asymptomatic pulmonary nodules.