Epstein-Barr virus associated with primary CNS lymphoma and disseminated BCG infection in a child with AIDS

Abstract

Background: AIDS patients are at increased risk of developing concurrent infections with viral, parasitic, fungal or mycobacterial organisms. They can present constitutional symptoms of fever and weight loss, either due to infections or an underlying lymphoma which may coexist.

Case report: A child with HIV-AIDS and mild encephalopathy is reported, who during the course of a confirmed disseminated mycobacterial disease developed neurological impairment. Post-mortem examination revealed disseminated BCG infection and Epstein-Barr associated primary CNS lymphoma. Epstein-Barr virus (EBV) presence was assessed by LMP-1 protein labelling by immunohistochemistry and in situ hybridisation (ISH) for Epstein-Barr virus-encoded RNAs (EBERs) in formalin-fixed and paraffin-embedded sections.

Conclusions: BCG vaccination among HIV-1 infected children leads to the risk of disseminated BCG infection. BCG immunization programmes should be reconsidered for children at risk of HIV infection, because the risk of delayed complications is independent of the immunological status at the time of the vaccination. Only isolated cases of primary CNS lymphoma occurring in HIV-infected children have been reported, and a striking association with EBV infection has been demonstrated.