A Case of HIV-Associated Primary Central Nervous System Lymphoma Refractory to Methotrexate-Based Systemic Therapy and Immune Reconstitution

Primary central nervous system lymphoma (PCNSL) exists as an HIV-associated malignancy, with its etiology driven primarily by Epstein-Barr virus (EBV) in the setting of absence of EBV-specific CD4+ T cell function, with CD4 counts averaging <50 cells/microliter. Before the development of antiretroviral therapy (ART), the treatment of HIV-associated PCNSL was primarily whole brain radiation therapy, which was fraught with long-term cognitive dysfunction. The availability of ART made the treatment of HIV-associated PCNSL possible to treat with curative intent. Here, we discuss a complex case of HIV-associated PCNSCL in a young male patient, wherein immune reconstitution combined with lymphoma-directed systemic therapy was ineffective in eradicating malignancy.