CRYPTOCOCCAL meningitis is a frequently described complication of malignant lymphoma. A patient with nodular, poorly differentiated lymphocytic lymphoma (a B-cell neoplasm) had a notable alteration in mental status. Examination of the CSF showed characteristic cryptococcal organisms, but also was believed to demonstrate CNS involvement with lymphoma. A T-cell rosetting assay proved clinically useful by identifying the atypical lymphocytes as T cells rather than neoplastic B cells.
Report of a Case
A 69-year-old man first came to the Minneapolis Veterans Administration Hospital in April 1973 with leg edema secondary to obstruction of the inferior vena cava. Laparotomy revealed a 12-cm mass. The histopathologic diagnosis was nodular, poorly differentiated lymphocytic lymphoma (PDLL). Several abdominal nodes were involved and a bone marrow biopsy specimen was positive for lymphoma.The patient was treated with cyclophosphamide and lomustine, with complete clinical response. However, two subsequent relapses required further therapy. The second relapse occurred in May
Davies SF, Gormus BJ, Yarchoan R, Kaplan ME. Cryptococcal Meningitis With False-Positive Cytology in the CSF: Use of T-Cell Rosetting to Exclude Meningeal Lymphoma. JAMA. 1978;239(22):2369–2370. doi:10.1001/jama.1978.03280490053025
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