• Andres M Alvarez-Pinzon, Jose E Valerio, Heather N Swedberg, Sammer M Elwasila, Aizik Wolf, and Jose R Alonso.
• Laboratory of Neural Plasticity and Neurorepair, Institute for Neurosciences of Castile and Leon (INCyL), University of Salamanca, E-37007, Salamanca, Spain; Neurosurgical Oncology & Neuroimmunology, Neurological Surgery Department, Miami Neurosciences Center, South Miami, Florida, USA. Electronic address: andresmauricioalvarez07@gmail.com.
• World Neurosurg. 2019 Apr 1; 124: 310312310-312.

BackgroundThe criterion standard for the treatment of newly diagnosed primary central nervous system lymphoma (PCNSL) remains high-dose chemotherapy in conjunction with palliative whole-brain radiotherapy; however, there may be a role for novel combined approaches in immunocompromised patients.Case DescriptionA 66-year-old man presented with acute cephalalgia, disorientation, and lethargy. His condition was evaluated in the emergency department, and he was admitted with probable hydrocephalus. Magnetic resonance imaging (MRI) of the brain revealed multiple nonspecific brain lesions, predominantly involving the right temporal lobe, which on biopsy led to a diagnosis of PCNSL. Subsequent laboratory studies demonstrated active human immunodeficiency virus (HIV) infection, with a CD4 count of 21 cells/μL and an HIV viral load (VL) of >400,000 copies/mL. The patient was eventually given highly active antiretroviral therapy (HAART). He declined palliative whole-brain radiotherapy but was amenable to gamma knife radiosurgery (GKRS) for treatment of the right temporal brain lesions. Three months later, the patient's neurologic symptoms had improved; similarly, his CD4 count increased to 176 cells/mL, and his HIV viral load was <90 copies/mL. By the 12-month follow-up visit, the patient was asymptomatic, and at 36 months, MRI of the brain demonstrated total remission without new brain lesions.ConclusionsThe criterion standard for treatment of newly diagnosed PCNSL remains high-dose chemotherapy in conjunction with palliative whole-brain radiotherapy; however, there may be a role for novel combined approaches using chemotherapy, HAART, and GKRS to have a positive impact on survival rates of PCNSL related to AIDS.Copyright © 2019 Elsevier Inc. All rights reserved.

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