Burkitt lymphoma associated with human immunodeficiency virus infection and pulmonary tuberculosis

Abstract

Introduction: The association of human immunodeficiency virus (HIV) infection with Burkitt lymphoma is related to the presence of Epstein Barr virus infection and the impact of the HIV antigen on the expansion of B-polyclonal cells. In Southeast Europe, the association is rare, and recognizing this is important in the therapeutic decision to increase patient survival rate. The association of HIV with Burkitt lymphoma and tuberculosis is even more rarely described in the literature. Patient concerns: We present the case of a 40-year-old patient who presented with a 3-week history of fever (max. 38.7 °C), painful axillary swelling on the right side, lumbar pain, gait disorders, headache, and night sweats. Clinical manifestations included marked weight loss (about 30 kg in the last 2 months before his admission). Diagnosis: A LyCD4 count of 38/μL and a HIV1 viral load of 384,000/mm 3 , classified the patient into a C3 stage. A biopsy of the right axillary lymph node was performed for suspected ganglionic tuberculosis due to immunodeficiency. Histopathological examination confirmed the diagnosis of Burkitt lymphoma. Cultures on Löwenstein-Jensen medium from sputum harvested at first admission were positive for Mycobacterium tuberculosis . Interventions: Highly active antiretroviral therapy, chemotherapeutic agents for Burkitt lymphoma, anti-tuberculous drug therapy, neurosurgical intervention of spinal cord decompression, and antibiotic therapy of the associated bacterial infection. Outcome: Burkitt lymphoma disseminated rapidly, with central nervous system, spinal cord, osteomuscular, adrenal, and spleen involvement. The evolution under treatment was unfavorable, with patient death occurring 6 months after diagnosis. Conclusions: The association of HIV infection with Burkitt lymphoma and tuberculosis is rare in the highly active antiretroviral therapy (HAART) era, posing prompt and multidisciplinary therapeutic management issues. Similar cases of HIV-TB and Burkitt lymphoma association have been described, but none of the other cases showed the involvement of the central nervous system or of the bilateral adrenal glands.

The Value of Nutritional Status in the Prognostic Analysis of Patients with AIDS-Related Lymphoma

“…Thus, there are several controversies regarding the value of albumin in reflecting the visceral protein. 20 , 29 While serum PA is not affected by systematic inflammation due to its short half-life (2–3 days), it is more sensitive to insufficient energy and protein intake than albumin and can better reflect the recent dietary intake. Therefore, serum PA may be used as an alternative nutritional marker and screening tool for malnutrition.…”

Long-Term Survival Rates and Treatment Trends of Burkitt Lymphoma in Patients with HIV—A National Cancer Database (NCDB) Study

“…Burkitt lymphoma accounts for 10-35% of AIDS-defining lymphoma in people with HIV, making it the second most common subtype of non-Hodgkin's lymphoma occurring in HIV-positive patients with a relatively high CD4 cell count [14]. Burkitt lymphoma (BL) in PWH is 261 times greater than that observed in the general population [15]. The heightened risk of Burkitt lymphoma in this population is explained by multiple mechanisms including immune dysregulation, EBV co-infection, direct effect of the HIV Tat antigen, and multiple other structural proteins on the proliferation of polyclonal B-cells [16].…”