Non-Hodgkin's lymphoma after prolonged remission of Hodgkin's disease in an HIV-infected patient

Abstract

Hodgkin's disease was diagnosed in a 22-year-old HIV-seropositive man in 1986. Alternate MOPP/ABVD chemotherapy induced a clinical remission. He was asymptomatic until 3 years later when fever and peripheral and mediastinal lymphadenopathy appeared. Lymph node biopsy showed a large-cell anaplastic lymphoma and EBV genome was identified in the malignant cells, suggesting that transformation might had been induced by EBV. The present case affirms that in patients with HIV-related lymphomas who present enlarging lymphadenopathy after stable remission, the development of lymphomas of higher malignancy needs to be ruled out.

PIP: A case is described of an HIV+ man who was successfully treated for Hodgkin's lymphoma, but who later developed non-Hodgkin's lymphoma 3 years later when his immune system became suppressed. The patient was 22 years old when he presented with fever, asthenia, weight loss, and cervical lymphadenopathy. With Hodgkin's lymphoma he also had positive serology for HIV and hepatitis B. He was treated with alternate courses of MOPP and ABVD chemotherapy. In 1990 he again appeared with high fever, progressive cervical, axillary and inguinal lymphadenopathy, with hilar and mediastinal lymph node enlargement on x-ray. CD4 lymphocytes were 577/cubic mm, and the CD4/CD8 ratio was 0.57 (normal 1.8). His cervical lymph node biopsy was classified as non-B non-T large-cell anaplastic lymphoma which was EBV-positive. A Western Blot was positive for small amounts of p24 and p18 antigens. The man was treated with MACOP-B chemotherapy, with some results, but died of sepsis 6 weeks later. The relationships between Hodgkins and non-Hodgkin's lymphoma, the timing of the neoplasm in the course of HIV infection, and the possible re-activation of hepatitis virus were discussed.