We describe a 37-year-old non-smoker who presented with dyspnea and a unilateral effusion secondary to Burkitt lymphoma (BL). The diagnosis was made by pleural tissue biopsy using video-assisted thoracoscopic surgery (VATS). Burkitt lymphoma is discussed.

Patients on HD are at a high risk of hepatitis B infection. Therefore hepatitis B vaccination is recommended for all HD patients, although compared with adults with normal immune status, the protective antibody response is lower and ranges from 34–88%. We hypothesized that HIV infected patients on HD are likely to have even lower antibody responses to hepatitis B vaccination. We therefore reviewed the immunization history of 16 HIV‐infected dialysis patients who received chronic maintenance HD at our dialysis units. The mean age of the patients was 43 ± 11 (mean ± SD). Of the 16 patients the majority were black males (13). The mean CD 4 count of these patients was 261 ± 206 (mean ± SD, range: 18–668 cells/μL). The mean viral load was 96727 ± 184084 (range 50–650846 copies/ml). Six patients had undetectable plasma viral loads. Of the 16 patients, 10 had protective antibodies (HBs Ab ≥ 10 mIU/ml). Of these 10 patients, 3 had positive Hepatitis core antibody suggesting previous viral exposure, another 3 were negative for HBcAb and in the remaining 4 HBcAb was unavailable. Five of the 10 patients with protective antibody received vaccination after starting dialysis. Pearson product moment correlation showed negative correlation of HBsAb with viral load, r = − 0.45, p value = 0.07. No correlation was found between CD4 count and response to vaccination. We conclude that HIV‐infected HD patients develop protective antibodies at a rate similar to HIV‐negative HD patients.

Hemodialysis (HD) patients with double-lumen vascular access catheters (D-VAC) are at substantial risk for bacteremia. In this regard, we have shown a rising incidence of gram-negative bacteremia in these patients from 2000-2004 (Alexandraki et al. J Am Soc Nephrol, in press). In a subset analysis of this cohort, 28% were also seropositive for hepatitis C (HepC), suggesting an association between the two infections. To further address this question, we identified a historical control group by reviewing the available medical records of 111 HD patients with D-VAC and bacteremia who received dialysis treatments at our institution between 2002 and 2004. In addition, the charts of 39 patients currently on dialysis and with a D-VAC were reviewed. For these 150 patients, demographics included age 48 6 3.9 years (mean 6 SEM), 47% male, and 81% African American. For this study all charts were screened for HepC serologies and a history of bacteremia. 146 patients met these entry criteria for the study. In this group, 131 patients (107 historical controls and 24 current patients) (90%) had a history of documented bacteremia (BAC), and 15 (10%) had never had an episode (CON). When compared to CON, BAC had a significantly higher incidence of HepC seropositivity (28 vs 7%, respectively, p = .042, chi square). When the historical controls were sorted by offending organism (gram-negative [GNO], gram positive [GPO], or polymicrobial [POLY]), there were no differences in the incidence of HepC seroconversion (9/32 [23%], 13/40 [27%], and 10/35 [24%] for GNO, GPO, and POLY, respectively). When sorted by offending organism, HIV seroconversion status did not differ among historical controls (0, 2, and 2% for GNO, GPO, and POLY, respectively). There were insufficient data in CON patients for an analysis of HIV status.ConclusionHepC seroconversion rates are higher in HD patients with D-VAC and bacteremia than in patients never experiencing a bacteremic episode. These data raise questions about possible immunomodulatory effects of HepC that may affect susceptibility to bacteremia. Showing a pathophysiologic role for HepC in D-VAC-associated bacteremia may influence approaches to HepC management and affect clinical decision making in patients with D-VAC.