LESI OTAK FOKAL DENGAN PCR EBV CAIRAN SEREBROSPINAL POSITIF PADA PASIEN AIDS DI RS CIPTO MANGUNKUSUMO

Background: Focal brain lesions in AIDS may be caused by opportunistic infections, cerebrovascular disease, and malignancy. In addition to toxoplasma encephalitis (TE) and tuberculomas, primary central nervous system lymphoma (PCNSL) is one of the etiology of focal brain lesions in AIDS. Positive examination of polymerase chain reaction (PCR) Epstein Barr virus in cerebrospinal fluid from some studies have high specificity and sensitivity, although the definite diagnosis PCNSL is through biopsy. Objective: To assess the clinical and radiological picture of AIDS patients with positive PCR EBV result on the cerebrospinal fluid. Results: Reported four cases of AIDS with focal brain lesions. Clinical manifestations of a gradual loss of consciousness accompanied by a progressive headache in three patients while the fourth patients the symptoms are only headache. Focal neurological deficits, cognitive impairment, and positive PCR EBV in liquor cerebrospinal (LCS) was found in four patients. The first patient, female, 42 years, value of CD4 20 cells/mL, LDH 1017 IU/L. Head MRI with contrast appears hiperintense and isointense lesions on T1, hiperintense inhomogen on T2 with a ring enhancement and minimal perifokal edema. She did not improve with TE empiric therapy. There were cognitive improvement by antiretroviral (ARV), but not optimal. The second patient, male, 28 years, value of CD4 38 cells/mL, LDH 884 I /L. He did not improve with TB and TE empirical therapy, his head MRI image was similar to the first patient. His liquor PCR of CMV was also positive, so he’s planned to receive gancyclovir. The third patient, female, 34 years, value of CD4 22 cells/mL, LDH 551 IU/L. His non contrast head CT scan appears isodense lesions in the pons. Patients did not receive any therapy because of Stevens Johnson Syndrome. Fourth patient, male, 28 years, value of CD4 89 cells/mL, LDH 691 IU/L. His head MRI shows hipointense lesion on T1 and turned hiperintense in T2. There is minimal perifokal edema, without contrast enhancement. He received TE empirical therapy and had a good treatment response. Conclusions: In AIDS patients with focal brain lesions and liquor cerebrospinal EBV PCR result is positive, PCNSL should be considered although this does not rule out other diagnoses such as TE and tuberculoma. Therefore biopsy remains necessary for definitive diagnosis.