Primary CNS Lymphoma Presenting With Seizures in a Virologically Suppressed HIV Patient With Near-Normal CD4: A Case Report From Uganda.

We report a case of primary central nervous system lymphoma (PCNSL) in a 40-year-old man with well-controlled HIV infection, virologic suppression, and a near-normal CD4 count who presented with new-onset generalized seizures and left lower motor neuron facial palsy. Brain MRI showed a large left temporal lobe lesion with irregular ring enhancement, marked vasogenic edema and mild midline shift. Lumbar puncture was deferred due to mass effect. The patient was stabilized with anticonvulsants and supportive care and transferred for stereotactic biopsy and oncologic management. Stereotactic brain biopsy confirmed PCNSL, and the patient was initiated on high-dose methotrexate-based chemotherapy with adjunctive dexamethasone. This case highlights that PCNSL can occur despite immunologic preservation in HIV and may present acutely with seizures. Early contrast-enhanced MRI, careful timing of corticosteroid use relative to biopsy, and timely referral are essential, particularly in resource-limited settings.