A 35-year-old HIV-positive patient (CD4+ count 80 cells/μL) presents with progressive cognitive decline, headache, and focal neurological deficits. MRI shows multiple non-enhancing white matter lesions with mass effect. Brain biopsy shows sheets of large B-cells with irregular nuclei around blood vessels. Which virus is most commonly associated with this condition?
- A JC virus
- B Cytomegalovirus
- C Epstein-Barr virus ✓
- D Human herpesvirus 8
Correct answer: C. Epstein-Barr virus
Explanation
Primary CNS lymphoma (PCNSL) in immunocompromised patients is a diffuse large B-cell lymphoma strongly associated with Epstein-Barr virus (EBV) infection. Nearly all AIDS-related PCNSLs are EBV-positive. JC virus causes PML, which shows non-enhancing white matter lesions without mass effect. CMV causes ventriculoencephalitis. HHV-8 causes Kaposi sarcoma and primary effusion lymphoma, not PCNSL.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.