Miliary pattern in secondary central nervous system T-cell lymphoma

BACKGROUND: Secondary central nervous system lymphoma may manifest in a variety of ways on imaging, but most commonly presents with leptomeningeal disease, isolated parenchymal lesions, or both. We present a case of secondary central nervous system T-cell lymphoma with miliary pattern of spread noted on imaging. CASE DESCRIPTION: Our patient had known systemic T-cell lymphoma involving the gastrointestinal and respiratory tracts and underwent stereotactic biopsy confirming secondary cerebral metastasis. This spread pattern is an uncommon manifestation of disease and in our experience carries a very poor prognosis. CONCLUSION: We highlight the need to maintain a broad differential diagnosis that includes other metastatic disease and infectious etiologies, including toxoplasmosis and tuberculosis. High clinical suspicion and timely confirmatory testing including biopsy or cerebrospinal fluid flow cytometry are critical to treatment.