Multifocal intracranial epstein-barr virus-associated smooth muscle tumors in an HIV-positive patient: incidental discovery and treatment with staged gamma knife radiosurgery.

INTRODUCTION

Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) is a rare mesenchymal neoplasm occurring predominantly in immunocompromised individuals, with central nervous system involvement exceptionally uncommon.

CASE PRESENTATION: A 36-year-old HIV-positive man underwent non-contrast head CT after a road traffic accident, which incidentally revealed multifocal extra-axial intracranial masses. MRI demonstrated avidly enhancing dural-based lesions with hemorrhagic components and venous sinus attachment, initially favoring multifocal meningioma. Subtotal resection of the dominant right parieto-occipital lesion demonstrated a low-grade spindle cell neoplasm with smooth muscle differentiation and diffuse EBER positivity, confirming EBV-SMT. All three lesions subsequently underwent two-stage Gamma Knife radiosurgery, with margin doses of 12 Gy and 14 Gy. Seven-month follow-up demonstrated relative lesion-size stability and central non-enhancing changes suggestive of treatment effect, without clinically apparent acute toxicity.

CONCLUSION

This case highlights the diagnostic overlap between intracranial EBV-SMT and meningioma and provides detailed documentation of staged radiosurgical treatment in multifocal disease.