Abstract Details

Title Diagnostic Delay due to COVID-19 Pandemic - A Case of Primary CNS Lymphoma

Topic Neuro-oncology

Presentation(s) Neuro-oncology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 045

Objective We describe a case of primary central nervous system lymphoma (PCNSL) where diagnosis/treatment was delayed due to the coronavirus disease 2019 (COVID-19) pandemic.

Background PCNSL is a rare aggressive extranodal non-Hodgkin lymphoma, rapidly fatal if left untreated. Corticosteroids can alter imaging appearance of PCNSL, requiring a high index of suspicion to establish the diagnosis.

Design/Methods Delay in care with diagnosis and treatment of PCNSL in the COVID-19 pandemic setting.

Results This 51-year-old woman on prednisone and oral methotrexate for uveitis presented with nausea, vomiting, and fatigue following exposure to an individual with confirmed COVID-19. Patient’s Coronavirus testing was negative. She deteriorated, developing ataxia, depression, and hypersomnolence. Outpatient neurology evaluation was delayed by 2 months after symptom onset due to the pandemic. Initial MRI brain findings including T2 hyperintensities involving periventricular white matter, basal ganglia, and cerebellar hemispheres with limited enhancement led to hospitalization. Demyelinating disease was suspected, methylprednisolone and plasmapheresis were administered. Patient became increasingly somnolent with spastic quadriparesis. Hospital visitation was limited to one person, starting noon for six hours a day. Bedside rounds were often completed by that time. Patient’s inability to advocate for herself due to altered consciousness likely added to diagnostic delay. Repeat MRI brain three weeks after admission demonstrated progressive white matter lesions with patchy enhancement. Brain biopsy confirmed diagnosis of diffuse large B-cell lymphoma (DLBCL), non-germinal center, double-expressor phenotype. She was started on high-dose methotrexate with signs of neurologic recovery.

Conclusions

PCNSL has variable manifestations potentially mimicking a variety of neurologic and psychiatric disorders. In this case, outpatient workup was prolonged due to COVID-19, imaging atypical from steroid treatment, patient unable to advocate for herself due to altered level of consciousness with restricted visitation during hospitalization, leading to significant diagnostic delay and development of neurologic disability.

Authors/Disclosures
Ugur Sener, MD PRESENTER	Dr. Sener has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Servier Pharmaceuticals. Dr. Sener has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Sener has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion.
Faraze Niazi	Ms. Niazi has nothing to disclose.
Tanvi Nadkarni, MD (Wvu)	Dr. Nadkarni has nothing to disclose.
Kristina J. Lopez, MD	Dr. Lopez has nothing to disclose.
Melanie D. Ward, MD	Dr. Ward has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Ward has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Celgene. Dr. Ward has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Ward has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Ward has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. The institution of Dr. Ward has received research support from Genentech.
Gauri V. Pawar, MD, FAAN (West Virginia University)	Dr. Pawar has nothing to disclose.

��ɫ��

��ɫ��