Mielite transversa como manifestação clínica inicial de linfoma não Hodgkin disseminado e mielopatia vacuolar associada ao HIV: relato de caso

Moura, Leandro P. de; Silvestre, Marco T. A.; Araújo, Fátima R. N.; Burgarelli, Marcius K. N.; Borges, Aércio S.; Vinhal, Fernando A.; Rocha, Ademir; Raffin, Cesar N.; Ferreira, Marcelo S.

doi:10.1590/S0004-282X1996000200023

Resumos

Linfomas não Hodgkin de alto grau são comumente relatados em pacientes com a síndrome da imunodeficiência adquirida (AIDS). Comprometendo com grande freqüência o sistema nervoso central, particularmente as leptomeninges e os hemisférios cerebrais. O acometimento epidural é pouco freqüente, variando de 3,5% a 8,3% de acordo com os registros da literatura. Os autores relatam o caso de um paciente de 27 anos de idade com AIDS, cuja manifestação clínica inicial da doença linfomatosa disseminada foi a mielite transversa associada à mielopatia vacuolar. Destaca-se a importância do diagnóstico diferencial precoce das mielopatias na AIDS, em virtude da alta malignidade da neoplasia e da evolução extremamente rápida nesses pacientes.

mielite transversa; linfoma não Hodgkin; mielopatia vacuolar; AIDS

Non-Hodgkin lymphoma is frequently seen in AIDS patients usually affecting the central nervous system (CNS), especially the leptomeninges and the cerebral hemispheres. The epidural involvement is rarely described, ranging from 3.5% to 8.3% among the CNS sites. The authors present a case of disseminated non Hodgkin lymphoma associated to vacuolar myelopathy in a 27 years-old male patient with AIDS emphasizing the importance of this differential diagnosis in the myelopathies of AIDS.

acute transverse myelitis; non-Hodgkin lymphoma; vacuolar myelopathy; AIDS

Mielite transversa como manifestação clínica inicial de linfoma não Hodgkin disseminado e mielopatia vacuolar associada ao HIV: relato de caso

Transverse myelitis as initial symptom of disseminated non-Hodgkin lymphoma and HIV-associated vacuolar myelopathy: case report

Leandro P. de Moura^I; Marco T. A. Silvestre^II; Fátima R. N. Araújo^II; Marcius K. N. Burgarelli^II; Aércio S. Borges^II; Fernando A. Vinhal^III; Ademir Rocha^IV; Cesar N. Raffin^V; Marcelo S. Ferreira^VI

^INeurologista

^IIInfectoIogista

^IIIResidente de Clínica Médica

^IVProfessor Titular de Anatomia Patológica, Departamento de Patologia

^VProfessor Titular de Neurologia - Departamento de Cirurgia

^VIProfessor Titular de Infectologia, Departamento de Clínica Médica

RESUMO

Linfomas não Hodgkin de alto grau são comumente relatados em pacientes com a síndrome da imunodeficiência adquirida (AIDS). Comprometendo com grande freqüência o sistema nervoso central, particularmente as leptomeninges e os hemisférios cerebrais. O acometimento epidural é pouco freqüente, variando de 3,5% a 8,3% de acordo com os registros da literatura. Os autores relatam o caso de um paciente de 27 anos de idade com AIDS, cuja manifestação clínica inicial da doença linfomatosa disseminada foi a mielite transversa associada à mielopatia vacuolar. Destaca-se a importância do diagnóstico diferencial precoce das mielopatias na AIDS, em virtude da alta malignidade da neoplasia e da evolução extremamente rápida nesses pacientes.

Palavras-chave: mielite transversa, linfoma não Hodgkin, mielopatia vacuolar, AIDS.

ABSTRACT

Non-Hodgkin lymphoma is frequently seen in AIDS patients usually affecting the central nervous system (CNS), especially the leptomeninges and the cerebral hemispheres. The epidural involvement is rarely described, ranging from 3.5% to 8.3% among the CNS sites. The authors present a case of disseminated non Hodgkin lymphoma associated to vacuolar myelopathy in a 27 years-old male patient with AIDS emphasizing the importance of this differential diagnosis in the myelopathies of AIDS.

Key words: acute transverse myelitis, non-Hodgkin lymphoma, vacuolar myelopathy, AIDS.

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Aceite: 30-janeiro-1996.

Faculdade de Medicina da Universidade Federal de Uberlândia, Minas Gerais

Dr. Leandro Pajuaba de Moura - Rua Johen Carneiro 825 - 38400-031 Uberlândia MG - Brasil Fax 034 218 2246.

1. Adams RD, Victor M. Diseases of the spinal cord. In Lamsbackwj, Navrosov M (eds). Principles of neurology. Ed5. Singapore: Mg Graw Hill, 1993;1078-U16.
2. Ahmed MD. Survival after herpes simplex type II myelitis. Neurology 1988;38:1500.
3. Berger JR. AIDS and the nervous system. In Aminoff MJ, (ed) Neurology and general medicine. Ed 2. New York: Chruchill Livingstone 1995;757-778.
4. Cinque P, Brytting M, Vago L, Castagna A, Parravicini C, Zanchetta N, Monforte A D, Wahren B, Lazzarin A, Linde A. Epstein-Barr virus DNA in cerebral spinal fluid from patients with AIDS-related primary lymphoma of the central nervous system. Lancet 1993;342:398-401.
5. Clanet M,, Rascol A, Rascol M. Les menigites à liquide clair. Encycl Med Cir. Neurologic 17160 CIO, 9-Paris: Editions Technique, 1981.
6. Forsyth PA, Yahalom J, DeAngelis LM. Combined-modality therapy in the treatment of primary central nervous system lymphoma in AIDS. Neurology 1994;44:1473-1479.
7. Goldstick L, Mandybur TI, Bode R. Spinal cord degeneration in AIDS. Neurology 1985;35:103-106.
8. Gray F, Gherardi R, Trotot P, Fenelon G, Poirier J. Spinal cord lesions in the acquired immune deficiency syndrome (AIDS). Neurosurg Rev 1990;13:189-194.
9. Haddad P, Thaell JF, Kieley JM, Harrison EG Jr, Miller RH. Lymphoma of the spinal extradural space. Cancer 1976;38:1862-1866.
10. Heller HM, Carnevale NT, Steigbigel RT. Varicella zoster virus transverse myelitis without cutaneous rash. Am J Med 1990;88:550-551.
11. Kaplan LD. HIV-associated non-Hodgkin*s lymphoma. HIV Adv Res Ther. 1992;2:9-15.
12. Kaplan LD, Abrams Dl, Feigal E, McGrath M, Kahn J, Neville P, Ziegler J, Volberding PA. AIDS-associated non-Hodgkin's lymphoma in San Francisco. JAMA 1989;261:719-724.
13. Katlama C. Manifestations neurologiques de l'infeccion à VIH. Encycl Méd Chir, Neurologic 17-051-B-10. Paris: Edition Technique, 1993.
14. Lennert K, Mohri N. Classification of non-Hodgkin's lymphomas. In Handbuch der speziellen pathologischen Anatomie und Histologic: Part B. Malignant lymphomas other non Hodgkin's disease. New York: Springer-Verlag, 1978:101-106.
15. Levine AM. AIDS-related lymphoma: clinical aspects and biology of disease. Adv Oncol 1991;7:18-25.
16. Levine AM. AIDS-associated malignant lymphoma. Med Clin N Am. 1992;76:253-268.
17. Levine AM, Wernz JC, Kaplan L, Rodman N, Cohen P, Mtroka C, Bennett JM, Rarick MU, Walsh C, Kahn J, Miles S, Ehmann WC, Feinberg J, Nathwani B, Gill PS, Mitsuyasu R. Low-dose chemotherapy with central nervous system prophylaxis and zidovudine maintenance in AIDS-related lymphoma: a prospective multi-institucional trial. JAMA 1991;266:84-88.
18. Livramento JA, Machado LR, Spina-França A. Anormalidades do líquido cefalorraqueano em 170 casos de AIDS. Arq Neuropsiquiatr 1989;47:326-331.
19. Loureiro C, Gill PS, Meyer PR, Rhodes R, Rarick MU, Levine AM. Autopsy findings in AIDS-related lymphoma. Cancer 1988; 62:735-739.
20. Olson EM, Wong WHM, Hesselink JR. Extraspinal abnormalities detected on MRI of the spine. AJR 1994;162:679-684.
21. Petito CK, Vecchio D, Chen YT. HIV antigen and DNA in AIDS spinal cords correlate with macrophage infiltration but not with vacuolar myelopathy. J Neuropathol Exp Neurol 1994;53:86-94.
22. Rhodes RH, Ward JM, Cowan RP, Moore PT. Immunohistochemical localization of human immumnodeficiency viral antigens in formalin-fixed spinal cords with AIDS myelopathy. Clin Neuropathol 1989;8:22-27.
23. Roland J, Braun M, Moret C, Blanchet B, Anxionnat R, Bracard S, Picard L. Imagerie médullorachidienne: scanographie et IRM. Encycl Méd Chir, Neurologie, 17-035-A-60. Paris: Editions Techniques, 1992.
24. Rosenblum M, Scheck AC, Cronin K, Brew BJ, Khan A, Paul M, Price RW. Dissociation of AIDS-related vacuolar myelopathy and productive HIV-1 infection of the spinal cord. Neurology 1989;39:892-896.
25. Sharif HS. Role of MR imaging in the management of spinal infections. AJR, 1992;158:1333-1345.
26. Sze G. MR Imaging of the spinal cord: current status and future advances. AJR 1992;159:149-159.
27. Tekkõk IH, Berker M, Õzcan OE, Õzgen T, Alkalin E. Brucellosis of the spine. Neurosurgery 1993;33:838-844.
28. Townsend RR. CT of AIDS-related lymphoma. AJR 1991;156:969-974.
29. Tucker T, Dix RD, Katzen C. Cytomegalovirus and herpes simplex virus ascending myelitis in a patient with acquired immune deficiency syndrome. Ann Neurol 1985;18:74-79.
30. Tyor WR, Glass JD, Baumrind N, McArthur JC, Griffin JW, Becker PS, Griffin DE. Cytokine expression of macrophages in HIV-1-associated vacuolar myelopathy. Neurology 1993;43:1002-1009.
31. Wiley CA, van Patten MD, Carpenter PM, Pwell HC, Thai LJ. Acute ascending necrotizing myelopathy caused by herpes simplex virus type II. Neurology 1987;37:1791-1794.
32. Woolsey RM, Chambers TJ, Chung HD, McGarry JD. Mycobacterial meningomyelitis associated with human immunodeficiency virus infection. Arch Neurol 1988;45:691-693.
33. Ziegler JL, Beckstead JA, Volberding PA, Abrams DI, Levine AM, Lukes RJ, Gill PS, Burkes RL, Meyer PR, Metroka GE, Mouradian J, Moore A, Riggs SA, Butler JJ, Cabanillas FC, Hersh E, Newell GR, Laubenstein U, Knowles D, Odajnyk C, Raphael B, Koziner B, Urmacher C, Clarkson BD. Non-Hodgkin's lymphoma in 90 homosexual men. N Engl J Med 1984;311:565-570.

Datas de Publicação

Publicação nesta coleção
06 Dez 2010
Data do Fascículo
Jun 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Adams RD, Victor M. Diseases of the spinal cord. In Lamsbackwj, Navrosov M (eds). Principles of neurology. Ed5. Singapore: Mg Graw Hill, 1993;1078-U16.

[2] 2. Ahmed MD. Survival after herpes simplex type II myelitis. Neurology 1988;38:1500.

[3] 3. Berger JR. AIDS and the nervous system. In Aminoff MJ, (ed) Neurology and general medicine. Ed 2. New York: Chruchill Livingstone 1995;757-778.

[4] 4. Cinque P, Brytting M, Vago L, Castagna A, Parravicini C, Zanchetta N, Monforte A D, Wahren B, Lazzarin A, Linde A. Epstein-Barr virus DNA in cerebral spinal fluid from patients with AIDS-related primary lymphoma of the central nervous system. Lancet 1993;342:398-401.

[5] 5. Clanet M,, Rascol A, Rascol M. Les menigites à liquide clair. Encycl Med Cir. Neurologic 17160 CIO, 9-Paris: Editions Technique, 1981.

[6] 6. Forsyth PA, Yahalom J, DeAngelis LM. Combined-modality therapy in the treatment of primary central nervous system lymphoma in AIDS. Neurology 1994;44:1473-1479.

[7] 7. Goldstick L, Mandybur TI, Bode R. Spinal cord degeneration in AIDS. Neurology 1985;35:103-106.

[8] 8. Gray F, Gherardi R, Trotot P, Fenelon G, Poirier J. Spinal cord lesions in the acquired immune deficiency syndrome (AIDS). Neurosurg Rev 1990;13:189-194.

[9] 9. Haddad P, Thaell JF, Kieley JM, Harrison EG Jr, Miller RH. Lymphoma of the spinal extradural space. Cancer 1976;38:1862-1866.

[10] 10. Heller HM, Carnevale NT, Steigbigel RT. Varicella zoster virus transverse myelitis without cutaneous rash. Am J Med 1990;88:550-551.

[11] 11. Kaplan LD. HIV-associated non-Hodgkin*s lymphoma. HIV Adv Res Ther. 1992;2:9-15.

[12] 12. Kaplan LD, Abrams Dl, Feigal E, McGrath M, Kahn J, Neville P, Ziegler J, Volberding PA. AIDS-associated non-Hodgkin's lymphoma in San Francisco. JAMA 1989;261:719-724.

[13] 13. Katlama C. Manifestations neurologiques de l'infeccion à VIH. Encycl Méd Chir, Neurologic 17-051-B-10. Paris: Edition Technique, 1993.

[14] 14. Lennert K, Mohri N. Classification of non-Hodgkin's lymphomas. In Handbuch der speziellen pathologischen Anatomie und Histologic: Part B. Malignant lymphomas other non Hodgkin's disease. New York: Springer-Verlag, 1978:101-106.

[15] 15. Levine AM. AIDS-related lymphoma: clinical aspects and biology of disease. Adv Oncol 1991;7:18-25.

[16] 16. Levine AM. AIDS-associated malignant lymphoma. Med Clin N Am. 1992;76:253-268.

[17] 17. Levine AM, Wernz JC, Kaplan L, Rodman N, Cohen P, Mtroka C, Bennett JM, Rarick MU, Walsh C, Kahn J, Miles S, Ehmann WC, Feinberg J, Nathwani B, Gill PS, Mitsuyasu R. Low-dose chemotherapy with central nervous system prophylaxis and zidovudine maintenance in AIDS-related lymphoma: a prospective multi-institucional trial. JAMA 1991;266:84-88.

[18] 18. Livramento JA, Machado LR, Spina-França A. Anormalidades do líquido cefalorraqueano em 170 casos de AIDS. Arq Neuropsiquiatr 1989;47:326-331.

[19] 19. Loureiro C, Gill PS, Meyer PR, Rhodes R, Rarick MU, Levine AM. Autopsy findings in AIDS-related lymphoma. Cancer 1988; 62:735-739.

[20] 20. Olson EM, Wong WHM, Hesselink JR. Extraspinal abnormalities detected on MRI of the spine. AJR 1994;162:679-684.

[21] 21. Petito CK, Vecchio D, Chen YT. HIV antigen and DNA in AIDS spinal cords correlate with macrophage infiltration but not with vacuolar myelopathy. J Neuropathol Exp Neurol 1994;53:86-94.

[22] 22. Rhodes RH, Ward JM, Cowan RP, Moore PT. Immunohistochemical localization of human immumnodeficiency viral antigens in formalin-fixed spinal cords with AIDS myelopathy. Clin Neuropathol 1989;8:22-27.

[23] 23. Roland J, Braun M, Moret C, Blanchet B, Anxionnat R, Bracard S, Picard L. Imagerie médullorachidienne: scanographie et IRM. Encycl Méd Chir, Neurologie, 17-035-A-60. Paris: Editions Techniques, 1992.

[24] 24. Rosenblum M, Scheck AC, Cronin K, Brew BJ, Khan A, Paul M, Price RW. Dissociation of AIDS-related vacuolar myelopathy and productive HIV-1 infection of the spinal cord. Neurology 1989;39:892-896.

[25] 25. Sharif HS. Role of MR imaging in the management of spinal infections. AJR, 1992;158:1333-1345.

[26] 26. Sze G. MR Imaging of the spinal cord: current status and future advances. AJR 1992;159:149-159.

[27] 27. Tekkõk IH, Berker M, Õzcan OE, Õzgen T, Alkalin E. Brucellosis of the spine. Neurosurgery 1993;33:838-844.

[28] 28. Townsend RR. CT of AIDS-related lymphoma. AJR 1991;156:969-974.

[29] 29. Tucker T, Dix RD, Katzen C. Cytomegalovirus and herpes simplex virus ascending myelitis in a patient with acquired immune deficiency syndrome. Ann Neurol 1985;18:74-79.

[30] 30. Tyor WR, Glass JD, Baumrind N, McArthur JC, Griffin JW, Becker PS, Griffin DE. Cytokine expression of macrophages in HIV-1-associated vacuolar myelopathy. Neurology 1993;43:1002-1009.

[31] 31. Wiley CA, van Patten MD, Carpenter PM, Pwell HC, Thai LJ. Acute ascending necrotizing myelopathy caused by herpes simplex virus type II. Neurology 1987;37:1791-1794.

[32] 32. Woolsey RM, Chambers TJ, Chung HD, McGarry JD. Mycobacterial meningomyelitis associated with human immunodeficiency virus infection. Arch Neurol 1988;45:691-693.

[33] 33. Ziegler JL, Beckstead JA, Volberding PA, Abrams DI, Levine AM, Lukes RJ, Gill PS, Burkes RL, Meyer PR, Metroka GE, Mouradian J, Moore A, Riggs SA, Butler JJ, Cabanillas FC, Hersh E, Newell GR, Laubenstein U, Knowles D, Odajnyk C, Raphael B, Koziner B, Urmacher C, Clarkson BD. Non-Hodgkin's lymphoma in 90 homosexual men. N Engl J Med 1984;311:565-570.