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CNS Lymphoma Diagnosis and Treatment / Lymphoma Diagnosis and Treatment / Viral Associated Cancers and Disorders · Journal article
Radiology Case Reports · July 24, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a case report of CNS involvement by EBV-positive extranodal T-cell lymphoma with STAT3 Y640F mutation in a post-allogeneic HSCT patient presenting with seizure and ring-enhancing lesion. The report emphasizes diagnostic difficulty when imaging resembles toxoplasmosis and highlights the importance of early tissue diagnosis in immunocompromised patients with progressive intracranial lesions.
Case report. Single 29-year-old male with chronic active EBV infection and prior extranodal NK/T-cell lymphoma post allogeneic HSCT presenting with seizure and intracranial lesion.. Intervention: Stereotactic biopsy.
29-year-old man presented with new-onset seizure and ring-enhancing intracranial lesion Initial imaging findings mimicked cerebral toxoplasmosis, delaying diagnosis Stereotactic biopsy revealed EBV-positive extranodal T-cell lymphoma with STAT3 p.Y640F activating mutation
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Clinicians should maintain high suspicion for CNS lymphoma in immunocompromised patients with progressive intracranial lesions unresponsive to empiric antimicrobial therapy, and pursue early tissue diagnosis to differentiate lymphoma from infectious etiologies such as toxoplasmosis. The presence of STAT3 activation may indicate aggressive disease requiring prompt intervention.
A single case report describing a rare presentation of CNS lymphoma with novel molecular findings; raises diagnostic and clinical awareness but provides no comparative data or outcome evidence.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should maintain high suspicion for CNS lymphoma in immunocompromised patients with progressive intracranial lesions unresponsive to empiric antimicrobial therapy, and pursue early tissue diagnosis to differentiate lymphoma from infectious etiologies such as toxoplasmosis. The presence of STAT3 activation may indicate aggressive disease requiring prompt intervention.
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Secondary central nervous system involvement by extranodal NK/T-cell lymphoma is rare and presents significant diagnostic challenges, particularly in immune compromised patients. We report a case of a 29-year-old man with chronic active Epstein-Barr virus infection and prior extranodal NK/T-cell lymphoma status post allogeneic hematopoietic stem cell transplantation who presented with a new-onset seizure and a ring-enhancing intracranial lesion. Initial imaging findings closely mimicked cerebral toxoplasmosis, leading to empiric antimicrobial therapy and delayed diagnosis. Despite treatment, the lesion demonstrated rapid progression, prompting stereotactic biopsy, which revealed Epstein-Barr virus-positive extranodal T-cell lymphoma with a pathogenic STAT3 p.Y640F activating mutation. This case highlights the substantial radiographic overlap between central nervous system lymphoma and infectious etiologies in immunosuppressed patients, where conventional imaging modalities may lack specificity. The presence of an aggressive molecular profile, including STAT3 activation, likely contributed to rapid disease progression and poor prognosis. This report underscores the importance of maintaining a high index of suspicion for lymphoma in patients with progressive intracranial lesions unresponsive to empiric therapy and emphasizes the critical role of early tissue diagnosis to guide appropriate management.
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