CD4-positive T-cell primary central nervous system lymphoma in an HIV positive patient

Ali Nael, Vighnesh Walavalkar, William Wu, Kambiz Nael, Ronald Kim, Sherif Rezk, Xiaohui Zhao

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objectives: Primary central nervous system lymphomas (PCNSLs) in patients with human immunodeficiency virus (HIV) are predominantly B-cell lymphomas associated with Epstein-Barr virus (EBV) and rarely CD8-positive T-cell PCNSLs. Methods: Patient history, laboratory results, cerebrospinal fluid (CSF), imaging, and brain biopsy specimens were reviewed and tested for T-cell receptor clonality. Results: A 64-year-old HIV-positive woman sought treatment for lethargy and left-sided weakness. Brain imaging showed regional increased T2 signal with restricted diffusion in cerebral hemispheres. CSF flow cytometry revealed CD4-positive T lymphocytes with loss of CD3, CD5, and CD7. EBV-positive T-cell lymphoma was immunohistochemically confirmed on brain biopsy specimens. Molecular analysis detected clonal T-cell receptor gene rearrangement. The patient received intrathecal methotrexate and whole-brain radiation. She did not respond to treatment and was eventually placed in hospice care. Conclusions: To our knowledge, this is the first report of CD4-positive T-cell PCNSL in an HIV-positive patient and will help to raise clinical awareness of this previously unknown entity.

Original languageEnglish (US)
Pages (from-to)258-265
Number of pages8
JournalAmerican journal of clinical pathology
Issue number2
StatePublished - Feb 1 2016


  • CD4-positive T-cell lymphoma
  • EBV
  • HIV
  • Primary central nervous system lymphoma

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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