Abstract Introduction Epstein-Barr virus (EBV)-positive Burkitt’s lymphoma is an aggressive B-cell neoplasm characterized by EBV infection and MYC oncogene translocation. We present the case of a 37-year-old male who originally presented with atypical neuro-ophthalmoplegic symptoms, leading to a challenging and delayed diagnosis. Case Description This patient’s 107-day hospital course was preceded by empiric outpatient treatment for sinusitis and three ER visits for headache, facial pain, and progressive left eye dysfunction initially treated as trigeminal neuralgia. MRI revealed rapidly enlarging bilateral cavernous sinuses masses initially concerning for thrombosis, with subsequent imaging revealing findings more consistent with neoplastic involvement. Hematologic malignancy was highly suspected due to left-shifted leukocytosis, thrombocytopenia, and elevated lactate dehydrogenase (LDH) levels. Subsequently, the patient developed lower extremity weakness and saddle paresthesia, with MRI showing spinal canal narrowing and epidural lipomatosis. Thoracic laminectomy and tissue biopsy confirmed high-grade, EBV-positive Burkitt’s lymphoma with IGH-MYC fusion. A modified McGrath chemotherapeutic regimen was initiated. While receiving inpatient chemotherapy, the patient developed Escherichia coli (E. Coli) bacteremia and distributive shock, which resolved with appropriate management. Following completion of chemotherapy, bone marrow biopsy and post-treatment PET imaging confirmed remission. After achieving hemodynamic stabilization, the patient was discharged to a skilled nursing facility for continued recovery. Discussion This case illustrates an exceptionally rare presentation of EBV-positive stage IV Burkitt’s lymphoma manifesting as bilateral cavernous sinus thrombosis. While Burkitt’s lymphoma is an aggressive B-cell malignancy, the patient’s early symptoms of unilateral facial pain and diplopia led to misdiagnosis of trigeminal neuralgia and sinusitis, underscoring the diagnostic challenges of atypical neuro-ophthalmologic presentations in systemic malignancy. The combination of bilateral cavernous sinus involvement and rapid progression to thoracic spinal lesions causing cauda equina-like symptoms demonstrate the disease’s capacity for widespread and aggressive dissemination. From a pulmonary and critical care standpoint, this case underscores the complex, multi-organ management required in advanced hematologic malignancy, complicated by E. coli bacteremia, distributive shock, and pancytopenia. Ultimately, this report expands the limited literature on Burkitt’s lymphoma presenting as cavernous sinus thrombosis and emphasizes the need to consider malignant causes in atypical or refractory cranial neuropathic syndromes. This abstract is funded by: None
Pierce et al. (Fri,) studied this question.