Isolated Intracranial Recurrence of Burkitt Lymphoma Complicated by Dural Thickening: A Case Report.

Burkitt lymphoma (BL) usually involves extranodal regions such as the bone marrow and central nervous system (CNS), but dural involvement is rarely reported. We report a case of the intracranial recurrence of BL involving the CNS, leptomeninges, and dura mater. The patient was a 76-year-old woman who presented with systemic lymphadenopathies, bilateral pleural effusion, and ascites. Laboratory examination showed elevated white blood counts with circulating abnormal cells and thrombocytopenia. Bone marrow examination revealed the presence of abnormal medium-sized lymphocytes with cytoplasmic vacuoles, and IGH::MYC fusion gene was detected in these abnormal lymphocytes. Thus, the diagnosis of BL was made. No CNS lesions were identified at diagnosis. A complete metabolic response was achieved by rituximab combination chemotherapy with prophylactic intrathecal chemotherapy, but isolated intracranial recurrence of BL occurred. In intracranial recurrence, dural involvement was observed in addition to the leptomeninges. High-dose chemotherapy was not effective for relapsed BL, and she died because of disease progression. At autopsy, subdural hematoma (SDH) and dural thickening were pathologically found. This is a rare case of isolated intracranial BL recurrence with dural involvement and nontraumatic SDH as a complication, and we reviewed previous reports of secondary dural involvement in BL. Our case showed the important viewpoint that in the case of dural involvement, clinicians should be aware of the nontraumatic SDH as a complication, and whole-brain radiotherapy may be the optimal treatment for isolated intracranial BL recurrence with dural involvement after rituximab combination chemotherapy.