Enunciado Male patient, 42 years old, infected with HIV for 15 years, on regular antirretroviral therapy (ART), was referred to Tertiary Care to investigate bradypsychia, mental confusion, walking difficulty, overall weakness (especially on the right), nausea, vomiting, diarrhea and low right visual acuity, with one month of evolution. Presented an episode of seizure without fever. Lumbar puncture was performed (which revealed atypical B-cell infiltration) and brain magnetic resonance imaging (MRI) was requested. Image 1: Brain magnetic resonance, axial view, FLAIR-weighted. Image 2: Brain magnetic resonance of the brain, axial view, diffusion-weighted (DWI) - (A) and apparent diffusion coefficient (ADC) Map - (B). Image 3: Brain magnetic resonance, sagittal view, T1-weighted, after the intravenous gadolinium-based contrast injection. Question:Considering the common disorders of the central nervous system (CNS) in patients with AIDS (Acquired Human Immunodeficiency Syndrome), what is the most likely diagnosis? Neurotoxoplasmosis Primary CNS lymphoma Progressive multifocal leukoencephalopathy Neurocryptococcosis Questão de Prova (State Health Department - Espírito Santo - Brazil) Regarding primary central nervous system lymphoma, related to HIV infection, check the correct option: It is diagnosed mainly by neuroimaging exams, with findings of diffuse brain lesions with little mass effect. The main differential diagnosis is progressive multifocal leukoencephalopathy. If possible, complete surgical resection of all identified lesions is desirable as standard treatment to avoid chemotherapy and radiotherapy. It is commonly one of the first AIDS-related complications to present in the patient because it requires a lower degree of immunosuppression than other HIV-associated diseases. The onset of this complication is strongly associated with Epstein-Barr virus infection. Epstein-Barr DNA sequences can be found in the CSF of most affected individuals. The most common clinical condition is progressive loss of muscle strength, which has been going on for more than twelve months, with signs of intracranial hypertension. Cognition is usually preserved. Time is Up! Time's up
