Presented with 6 months of bilateral hip pain 

2 months - loss of sensation below umbilicus

1 month - progressive quadriparesis with bowel bladder dysfunction

2 weeks - dysarthria and dysphagia 

Physical examination: 

Two hard, non-tender, 3-cm masses at bilateral parietal skull, right cervical lymphadenopathies

Neuro: dysarthria, Lt LMN facial palsy, impaired tongue protrusion both sides but no tongue atrophy

Motor power upper ext. gr.V all, lower ext. gr. II all

DTR upper ext 2+ all, lower 1+ all, Tone is not increase.

Clonus neg, Babinski sign - absent

Decrease pain and temperature sensation below T12 level

Impaired proprioception and joint sense vibration of both lower extremities

PR : loose spincter tone

Investigations: 

MRI brain 

Hip bone biopsy and Bone marrow biopsy: Burkitt Lymphoma 

Final diagnosis:

Burkitt Lymphoma with spinal cord compression, Base skull involvement (involve cranial nerves), hip bone metastasis, bone marrow metastasis

HIV-related Burkitt Lymphoma

• 70 to 90 percent of HIV-related lymphomas are highly aggressive and are almost the immunoblasticvariant of DLBCL and Burkitt lymphoma
• HIV-related Burkitt lymphoma frequently develops in younger patients and/or when CD4 count is relatively high, typically over 200 cells/microL
• Requires intensive, frequent multi-agent therapy with adequate CNS prophylaxis
• Less intensive regimens (eg, CHOP) are not adequate therapy as they result in frequent relapses
• Regimen eg.
  • CODOX-M plus IVAC ("Magrath regimen") 
  • CALGB 9251
  • HyperCVAD 
  • Dose-adjusted EPOCH
  • Incorporation of rituximab

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